Los Angeles Anthem Denial Based on Material Misrepresentation

According to the California Nurses Association/National Nurses United, 26 percent of all healthcare claims are denied in the state. Insurance companies have an arsenal of seemingly valid excuses at their disposal to support their intent not to pay your claim. After all, in order to be successful, they must make a profit. In order to make a sizeable profit, they simply cannot pay every claim they receive.

One of the excuses an insurance company such as Anthem can make in an effort not to pay on your claim is material misrepresentation. If you have received a Los Angeles Anthem denial based on material misrepresentation, contacting a well-versed insurance attorney may be in your best interest.

What is Material Misrepresentation?

Insurance companies have the right to rescind a policy, which is also a contract if they believe the insured party lied or omitted information. Material misrepresentation is the layman’s term for this law.

Material misrepresentation is one reason for an insurance company to deny a claim or rescind a policy completely. However, under these insurance codes, the insurance company must be able to prove that they would have charged the insured a higher premium if they had known the complete truth. In order to fight against Los Angeles Anthem denials based on material misrepresentation, it is important to speak with a detail-oriented attorney who can fully review the policy.

Defenses Against Anthem Denials

For those facing a Los Angeles Anthem denial based on material misrepresentation, an effective defense strategy must be built. One common defense is the insured simply made an innocent mistake on their application for coverage. The questions asked on these applications can be confusing, use higher-level or medical terminology, or have an open-ended interpretation. Since they likely completed their original application with little to no help from the insurance carrier, it is easy to make a mistake.

The insurance carrier then uses that information to determine the policy rate. To further add to the problem, most insurance companies do not and are not required to verify the answers to all of the questions.

When this happens the insurance company is in an ideal situation. They collect premiums and agree to the insurance policy. However, when the insured makes a claim on the policy, they can cancel the policy and deny paying the claim. Money comes in and due to not paying on policy claims, it does not come back out.

Disputing a Los Angeles Anthem Denial Based on Material Misrepresentation

A Los Angeles Anthem denial based on material misrepresentation is not something you should have to face alone. A dedicated lawyer believes in educating policyholders about these issues and pursuing justice. They can take the time to understand what has happened and how it might be affecting you and your family.

It is best to consult an attorney with frequent and extensive experience practicing insurance law. They can help you work towards a desirable outcome. To get started, call today.