Should spotlight on insurer re denied claim always be adverse?

| Sep 26, 2018 | workers compensation insurance defense

The short and immediate answer to the above-posed blog headline query must certainly be this: Of course not.

Candidly, though, insurance companies often get the short end of the proverbial stick from a public relations perspective in stories targeting claim denials. Such tales are often couched in terms of a good-versus-bad perspective. The shorthand version often stresses a vulnerable, disadvantaged and righteous policyholder facing a bureaucratic colossus with seemingly inexhaustible resources and bad-faith intent.

Stories with a plot line anything similar to that are virtually guaranteed to command substantial media play.

Like this one, for instance. It involves a woman living in a park catering to recreational vehicles. She suddenly became ill recently with what was subsequently diagnosed as a kidney infection. A local emergency room doctor deemed her condition so serious that he directed her transfer to another facility. She was flown there in an air ambulance.

The insurer with whom she had a travel-related policy refused to pay for the service, citing explicit contractual language for the denial. A policy clause stating that evacuation costs would be covered “only if we have given our prior approval and if those expenses are coordinated by us” was pointed to specifically. The woman had failed to comply with that obligation.

She argued dire medical necessity as justification for acting before receiving approval, of course, and it is certainly arguable that she had a point.

The bottom line, though, is that such cases have unique facts in every instance and that it is not really fair for third parties to make judgment calls absent all the relevant details. Insurance companies do indeed come in for fair criticism sometimes, but they are also commonly maligned in unfair fashion.

Insurance claim-linked cases are often intricate and complex affairs pursuant to which insurers need proven legal assistance every bit as much as policyholders do. An experience insurance defense law firm can provide it for them.