Damages for Los Angeles Anthem Health Insurance Claims Denials

Anthem provides health insurance to over 74 million people nationally and specifically to thousands of people in the Los Angeles region. However, simply having health insurance with Anthem does not ensure that your claim will be approved, and thousands of people find their health insurance claims denied for a variety of reasons.

Health insurance policies and litigation are intricate and complex and require a thorough understanding of your health insurance policy, as well as the underlying laws and regulations. If your health insurance claim has been denied, you may be entitled to recover significant compensation for your injuries and losses.

Legal Protections Against Health Insurance Denials

It is important for anyone who is covered by Anthem health insurance to know that they have legal rights in the event of a health insurance claim denial. Insurance policies are treated very similar to contracts: in exchange for the policyholder paying a premium, Anthem has a legal duty to provide coverage and uphold the terms of their policy.

If Anthem unreasonably denies an individual coverage under their policy, they may be entitled to file a bad faith claim. In other words, if a court finds that an insurance company has engaged in bad faith in denying a health insurance claim, the person whose claim was denied may be entitled to significant compensation to cover their injuries and losses.

Recovering Compensation for Breach of Health Care Policy

What kind of damages a person can recover in an action for breach of insurance contract is determined by whether their health policy is governed by California law or ERISA. In an ERISA action, an insured is only entitled to contractual damages, i.e. the benefits of the contract that were improperly denied, and potentially attorneys’ fees. In a non-ERISA action, a policy-holder can seek bad faith extra contractual damages, also known as tort damages. These can include damages for physical injury, pain and suffering, emotional distress and potentially attorneys’ fees. Such an individual can also pursue punitive damages to punish the insurer for its bad faith conduct in denying health care.

How to Calculate Damages

When a court is determining a damage amount in ERISA cases, it generally looks to ascertain clear losses, often in the form of quantifiable damages such as health care bills. Indeed, in most cases, an individual is simply seeking to have their health care expenses covered under their policy.

In non-ERISA actions though it is important to examine whether a person was impacted in other ways other than simply facing medical bills, which entails examining the physical and emotional impact of a health insurance claim denial. For example, if a person unjustly had their health insurance claim denied for a surgery and thereafter suffered complications because they could not have their procedure performed, the health insurance company could be held liable for any additional expenses.

Holding Insurance Companies Liable through Punitive Damages

Health insurance companies such as Anthem are just that—companies. This means that some firms may have company-wide policies that negatively impact individual policyholders.

If insurance companies engage in this type of conduct, they may be punished through punitive damages. In order to receive punitive damages for a health insurance claim denial, a plaintiff must prove that Anthem acted in bad faith and that Anthem’s conduct was malicious, fraudulent, or oppressive, as defined in California Civil Code §3294.

Get Help Seeking Damages for a Los Angeles Anthem Health Insurance Denial

If Anthem denied your health insurance claim, you have the right to appeal this decision. However, if even after an appeal you feel that your health insurance claim was denied in bad faith, you are entitled to file a lawsuit to recover damages to cover your medical expenses, injuries, losses, and even to punish an insurance company for engaging in a pattern of fraudulent behavior. Call a dedicated local lawyer today for more information.