Having a claim for mental health or rehab coverage denied can hit hard at a difficult time in your life. An experienced Inland Empire insurance claims denial lawyer at Quincey Law can help you fight back.
Employees who work for private sector companies have more limited protections, even though there is a law that exists for the purpose of ensuring their legal rights. When you work for a public sector employer, this restrictive law does not apply. You are getting an additional level of review that can be for your benefit, and you have the ability to potentially sue the insurance company directly.
Schedule a free initial consultation with an Inland Empire insurance claims denial lawyer at Quincey Law. Our job is to stand up for your legal rights at every step of the way.
ERISA Does Not Apply to Public Sector Employees
When an employee who is working in the private sector is injured, they would be seeking medical coverage through insurance that is provided by their job. What can make this more challenging is the presence of a federal law called ERISA. Although the intention of this law was to provide greater protections for employees, the actual effect of it has been the opposite.
Under ERISA, you would need to follow a specific procedure that gives the insurance company a greater amount of power. For example, when you want to appeal the denial of coverage, you would need to go through the insurance company first before you can get your day in court. Practically speaking, there is little chance that an insurance company would reverse their own decision. Then, when you take your case to federal court, the judge may apply a deferential standard of review that could result in the insurance company’s initial decision being upheld. Finally, you do not have the ability to sue an insurance company for bad faith under ERISA. The best that can happen is that you can have the court compel them to provide you the benefits that you deserve under the terms of their policy.
You Have Stronger Protections and the Ability to Take on the Insurance Company Directly
When you are a public employee, you have additional protections that you otherwise would not have had if you worked for a private employer. The reason for this is that ERISA does not apply to public sector employees. The law states that ERISA excludes plans that are “established or maintained for its employees by any State or political subdivision thereof.”
To be clear, there is still an appeal procedure that you may follow, but there may be a better chance that you can overturn the initial denial of your claim. Here, you may first go through the insurance company’s internal appeals process, just like you would under a claim based on ERISA. Assuming that the insurance company denies your appeal, as often happens, you would then have an additional level of review, where you have the potential for success. Ordinarily, ERISA would pre-empt state law, but since it does not apply, you would follow the procedures outlined under the Knox-Keene Act.
The California Department of Managed Health Care (DMHC) provides an additional level of review that is not present under ERISA. They would determine whether the denial was compliant with the terms of your policy. They could compel the insurer to cover your claim. If the result of DMHC review is not favorable, you may still file a lawsuit against the insurance company in state court.
The other protection that you have as a public employee that you do not have under ERISA is the ability to sue the insurance company directly for bad faith. If the insurance company has broken the law in their denial of your claim, you could seek monetary damages directly from them. Depending on who you are suing, you may even be able to receive punitive damages if a jury finds that the defendant egregiously broke the law. The prospect of a bad faith lawsuit could be enough to force the insurance company to fall in line when they are acting in an unreasonable manner.
Contact an Inland Empire Insurance Claims Denial Law Firm
When you need an experienced Inland Empire insurance claims denial attorney who is unafraid to take on big business, reach out to Quincey Law. We can wage the battle that is necessary on your behalf to get the coverage you deserve under the terms of your policy. You can schedule a free initial consultation by filling out an online contact form or by calling us today at (866) 945-9175.
Information about Quincey Law
Quincey Law is a client-centered personal injury and bad faith insurance firm serving individuals across California, with offices in Rancho Cucamonga and Dana Point. Founded by Attorney Nicholas Quincey, the firm is dedicated to fighting for those suffering from serious injuries or unfair insurance denials, taking on major insurers to secure rightful compensation. The legal team is bolstered by Of-Counsel Attorney Brian Brandt, a seasoned trial lawyer who has recovered hundreds of millions for catastrophic injury victims since 1987. Together, they provide experienced, results-driven representation with a proven history of success.
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