Los Angeles Anthem Health Insurance Breach of Contract Lawyer

Dealing with health insurance companies can often be frustrating and stressful. You may worry about your rates going up or a claim being denied. However, remember that when Anthem wrongly denies a healthcare claim, raises rates, or acts in other manners that are not in accordance with your policy, you have rights.

If you believe that Anthem is not adhering to the terms of your policy, a Los Angeles Anthem health insurance breach of contract lawyer can help you. A well-versed health insurance attorney can work with you submit a detailed appeal so you can have a greater chance of getting the coverage you need.

Understanding Anthem Insurance Policies

At its most basic level, an insurance policy is a contract between the policyholder and the issuing company. This contract defines the rights and responsibilities of both parties. When the policy is issued, the insurance carrier signals their agreement with the contract. By accepting and paying for the policy, the insured is indicating their agreement as well.

To better understand the rights and responsibilities of both parties, the insured should read through their policy documents. There are some important points to understand within the contract.

The Insuring Agreement

This portion of the policy sums up the major points in the contract and what rights and responsibilities both the insurer and the insured have in the agreement. Health insurance companies often refer to these documents as the Evidence of Coverage or E.O.C. for short.


These are circumstances that are not covered by the policy. For example, if the insured participated in risky behavior such as skydiving and was injured, the insurance company may not have to pay on any related insurance claims if this is clearly communicated in the exclusions section. Further, there are types of services or treatments that are explicitly excluded from coverage under the terms of the health insurance policy or health plan document.


These are provisions of the contract that can limit the insurance carrier’s responsibility to pay or perform under the contract. If the policy conditions are not met, the insurance company can legally deny a claim.

Breaches of an Insurance Contract in Los Angeles

Since health insurance policies are contracts, both parties must adhere to California contract laws. For instance, the insured party must pay their premiums to maintain coverage and the health insurance company must pay claims in accordance with what is stated in the policy.

Common ways in which insurance companies breach their own contracts include:

  • Failure to investigate a claim
  • Denial of a legitimate claim
  • Denial of benefits as outlined in a contract
  • Unreasonable interpretation of a contract
  • Failure to provide a defense against a claim
  • Delayed or insufficient payment the claimant

Policyholders who believe their health insurance company has breached their contract with them should first review their policy documents. They may also want to speak with Anthem to determine what exactly they are refusing. A Los Angeles Anthem health insurance breach of contract lawyer can also help the insured party determine whether Anthem has breached their contract.

How a Los Angeles Anthem Health Insurance Breach of Contract Attorney Can Help

You can stand up for your rights by contacting an experienced Los Angeles Anthem health insurance breach of contract lawyer. It is wrong for Anthem or any other insurance company to not uphold their end of the contract, but an attorney can help you seek justice.

A qualified insurance attorney may be able to settle the breach of contract with Anthem before the case ever goes to court. If not, your attorney is trained to help the court understand what the policy means and how Anthem has breached it. To learn more, call today.