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Insurance Denied Your Claim, What Can You Do?

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Insurance Denied your Claim, Now What?

The main objective for insurance companies is to make money. Insurance companies are no different than any other business with shareholders. They exist to maximize profits. I don’t begrudge insurance companies for trying to make money, again, that’s their business. But, an Insurance Denied your Claim, and that’s an extreme burden. I like to know where everyone’s loyalties lie, so next time you watch a cute ad with a cool jingle, it is important to remember the insurance’s priority. It is best to remember what comes first. Don’t be tricked by a charming spokesperson with a catchy jingle. An insurance company can’t survive if it pays out more in benefits than it collects in premiums.

Can Insurance Limit my Medical Treatment

Due to the realities discussed above, an insurance company may try to limit your medical treatment. However, they are not in charge of your medical treatment. Your physician is in charge of your treatment plan. You should know that an insurance company cannot prevent you from receiving treatment. Any insurance that attempts to get between you and your treating physician is acting inappropriately.

Insurance Denied Your Claim

Remember that insurance can’t prevent treatment but they can decline to pay for it. The insurance may claim that a particular procedure is not covered by the insurance policy. This can occur with your own insurance as well as a claim submitted to an insurance of an at fault third party. The insurance may argue that the procedure was unnecessary to provide you with the best potential recovery, which often appears in the form of “experimental treatment”.

Options for Pursuing my Denied Insurance Claim

You have several options if the insurance denies your claim. The best results will likely come through the pursuit of a personal injury lawsuit. The second option is to present your case through arbitration or something similar. The least effective way would be to appeal the denial internally through the insurance company. Remember, your priority is to receive reimbursement for your medical treatment. An insurance companies priority is to make money, and they make less money the more they give to you.

If you were injured by someone else’s poor judgment, then it is probably best to pursue a personal injury lawsuit. You may be able to receive compensation from the at fault party and relief some of the burden caused by your injuries. I know many of you don’t like the idea of pursuing a lawsuit, but in reality it is the most peaceful way of resolving disputes and allocating the societal burden of your injuries to the responsible party.  Thank you for reading this article, if you’d like to read more, I suggest reading my latest post on Settlements. 

 

Settlement

By | Articles, Bike Accidents, Car Accidents, Casino Accidents, Construction Accidents, Dog Bites, Medical Malpractice, Personal Injury, Trucking Accident, Wrongful Death | No Comments

You’ve reached a settlement. The journey that began when someone’s careless actions hurt you,  has finally come to a close. Besides feeling relief, you’re probably wondering what happens next. What is required in a settlement by both the plaintiff and defendant. There’s several steps that occur between the time a case settles and having a check in your hands. Each process is contingent on what kind of settlement is reached. The different types of settlements are primarily based on if the person hurt is an adult, minor, or if it involved the wrongful death of a person.

“A Settlement is an official agreement intended to resolve a dispute or conflict.”

Whenever a case settles, the parties need to sign a release agreement. As part of the settlement, your attorney will send you a Release Agreement to sign. Your attorney will also send another document called a stipulation to dismiss. It’s imperative to put in a timetable for payment in the release. The Release Agreement is a document that specifies the terms between the parties. For example, in exchange for $250,000, you agree to release Mr. Jones from the car accident. Upon receipt of the settlement check, it is deposited in a trust account. Once the settlement funds become available, a check to you for your portion should be delivered.

When a claim involves injuries sustained by someone under the age of 18, the settlement requires court approval. A petition is submitted to the court specifying the terms of the settlement. The petition sets forth the amount agreed to, case expenses and legal fees. It also specifies why the agreement is in the best interests of the child. A Judge will then schedule a hearing where your petition will be presented to the court. This hearing is largely a formality but it is still important to take it seriously. Once the Judge affirms the petition, you will be requested to consent to a Release Arrangement as described above.

In a wrongful death lawsuit, there are usually claims for pain and suffering and wrongful death. Pain and suffering refers to the conscious pain and suffering of the decedent prior to death. Wrongful death refers to the monetary losses sustained by the beneficiaries of the decedent’s estate, such as loss of income, loss of maternal guidance, advice, and burial expenses. The portion of the settlement allocated to wrongful death is divided according to the loss sustained by each beneficiary.

What’s important to remember is that every case is complicated. A settlement is one of the last steps involved in litigation, but it’s definitely not the finish line.

Wrongful Death

By | Articles, Car Accidents, Casino Accidents, Construction Accidents, Train Accident, Trucking Accident, Wrongful Death | No Comments

At some point in your life, you’ve likely known someone who was injured in an accident, either at work or in traffic.  Accidents are a fact of life, and unfortunately, sometimes accidents result in the death of an individual.  When this happens, Utah law provides for the compensation of dependents and family members.  However, most people have no idea where to begin when their loved one dies as the result of the negligence or wrongdoing of another party.

Not a single person reading this sits around contemplating the wrongful death of a family member or a close personal friend.  Tragedies are unthinkable outcomes, and wrongful death is not an everyday occurrence in our lives.  We live our lives among our friends and loved ones, secure in their company and comforted by their continued presence in our day to day lives.

A wrongful death is the absolute worst case scenario for many of us, but if and when it happens to your spouse, your child, or someone you know, a crash course in the law is usually what ensues. At a time when you’re grieving the loss of someone close to you, the law is the last thing on your mind.  That’s why you need to contact an attorney.

An attorney is your advocate during the most unimaginably heartbreaking time.  They’re your guide, and when you’ve lost a loved one, you need to focus on healing and recovery.  Very often, the person you lose can be a breadwinner, a provider, a mother, a father, an adult child taking care of elderly parents or a disabled spouse or child.  The loss isn’t just emotional; it’s financial.  Life insurance and the estates a deceased individual leaves behind are often not enough to ensure the future of their surviving relatives.

In the event that a child dies as a result of negligence or wrongdoing, parents and siblings are left with the knowledge that no amount of money can bring their child back to life.  However, civil damages are intended to both compensate a loss that cannot be quantified, and deter the wrongful conduct that resulted in the loss of a child.

Second, Utah law limits wrongful death claims to the heirs of the deceased victim, or a personal representative of the deceased. Who are the heirs under Utah law?

1. A surviving spouse, such as a husband or a wife.
2. A surviving adult child.
3. A surviving parent or parents either natural or adoptive.
4. The surviving stepchildren, if they are under 18 at the time of death and dependents of the deceased person.
5. Any other blood relatives listed in Utah’s inheritance laws.

The presumption under Utah law is that one of the heirs will take on the role of personal representative for the deceased; however, if the deceased died with a will or an estate plan, they may have named a personal representative who can also file a wrongful death claim. The personal representative has to file in civil court. This is the person who will contact and hire an attorney to deal with those responsible for the wrongful death and their insurance company.

Third, you have to file within two years of the deceased’s death.  If the negligent party is a government entity, you only have one year to file.

Finally, you can recover damages under Utah’s wrongful death law. These damages can include the following:

1) Compensatory damages for:
-Medical expenses related to the injury causing the death.
-Lost wages, such as future wages and benefits lost.  This means that you should be able to  recover the wages the person would have made if they were still alive to work.
-Pain and suffering resulting from the death.
-The loss of companionship, guidance, and care.  Very often, the deceased will be a spouse or  parent whose loss cannot be quantified in mere lost wages.  Children rely on their parents for  guidance and care, and spouses rely on their other half for companionship and care as well.

2) Punitive damages: these damages are intended to send a message, and that message is that the negligent or intentional behavior that resulted in a wrongful death should not be tolerated or repeated. Punitive damages are awarded to punish intentional or negligent behavior, and they are also awarded to discourage that behavior in the future.

We all hope that we never have to deal with the aftermath of wrongful death, but if and when we do face that horrific possibility, knowledge is the key.  The Personal Injury Education Center of Utah is a resource to give you the knowledge you need when the unthinkable occurs.