Brownsville Insurance Claims Lawyer

No matter the type of claim, whether it involves windstorm or hail damage, business issues, life insurance, fire and smoke damage, water damage, or any other coverage dispute, our Brownsville insurance claim lawyer has the skills and knowledge to help the parties work out a resolution.

Our track record includes handling thousands insurance claim cases. Call Mendez Law Firm today at (956) 983-9673 or fill out a contact form to schedule a consultation. We work with both English and Spanish-speaking clients.

What is a Bad Faith Insurance Claim?

A bad faith insurance claim arises when an insurance company fails to uphold the terms of its contract with a policyholder, acting in an unreasonably obstructive manner. This can include a range of behaviors, from unjustly delaying or denying a claim without a valid reason, failing to conduct a proper investigation into the claim, or not paying out the full, agreed-upon amount for a valid claim. Essentially, it involves the insurer knowingly acting in a way that is contrary to their obligations under the insurance contract.

At the core of every insurance policy is an implied covenant of good faith and fair dealing. This legal principle requires both the insurer and the insured to act honestly and not mislead or withhold critical information from one another. When an insurance company breaches this covenant by engaging in deceptive practices such as unreasonable delays, denying rightful claims, or significantly underpaying, they can be said to be acting in bad faith.

Bad faith insurance practices can significantly harm policyholders, leaving them without necessary financial support during critical times. Recognizing these actions is crucial for policyholders who suspect that their insurance company is not acting in their best interest. By understanding what constitutes a bad faith claim, individuals can better advocate for their rights and seek appropriate legal recourse to challenge unjust insurance practices and secure the compensation they are rightfully owed.

What Are The Common Reasons for Insurance Claim Denials?

Insurance claim denials can occur for various reasons, some of the most common ones include:

• Lack of Preauthorization: Services or treatments that require preauthorization may be denied if the necessary approval was not obtained before receiving care.
• Non-Covered Services: Insurance policies have limitations on what they cover, so claims for services not included in the policy may be denied.
• Coding Errors: Incorrect medical codes or incomplete information on the claim form can lead to denials.
• Billing Errors: Mistakes in billing such as duplicate charges, incorrect patient information, or inaccurate billing codes can result in denials.
• Timely Filing: Claims must be submitted within a certain timeframe after services are rendered; failure to do so can lead to denials.
• Policy Lapses: If the policy was inactive or lapsed at the time of service, claims may be denied.
• Missing Documentation: Inadequate or missing documentation to support the claim can result in denials.
• Medical Necessity: Insufficient evidence of medical necessity for a procedure or service can lead to denial of the claim.
• Out-of-Network Providers: Seeking care from providers outside of the insurance network may result in claim denials unless under specific circumstances.
• Coordination of Benefits Issues: When a patient has multiple insurance plans, coordination of benefits errors can lead to denials.

Understanding these common reasons for insurance claim denials can help individuals navigate the process more effectively and potentially avoid denials in the future.

Struggling with an insurance dispute in Brownsville? Reach out to the Mendez Law Firm fight for the compensation you deserve.