HMO Insurance Misconduct

HMO Insurance Misconduct: Learn About Your Legal Options by Speaking with a Cook County Injury Lawyer Today.

Insurance companies have a legal duty to deal fairly and in good faith with their policyholders and meet all reasonable expectations of policyholders as outlined in their policies. But insurers consistently attempt to deny claims as common practice. To prove HMO insurance misconduct, you – the policyholder – must show that the insurer failed to honor its contract and had no cause to deny a claim that you filed. Our firm can help you with this task and the many other tasks you must complete to pursue legal action against your insurer. If you reside in Cook County, an injury lawyer from our firm will evaluate your case at no cost.

The list of offenses that illustrate an insurance carrier’s bad faith is quite long. Common behaviors can include:

  • Failure to verify promptly that the HMO receives a claim
  • Unreasonable requests, such as drowning you (and your doctor) in needless paperwork and bureaucratic red tape
  • Unjust claim denial, usually accompanied by failure to provide a reasonable explanation promptly when denying a claim or countering lesser compensation amount than the policy provides.
  • Careless or incomplete claim investigations
  • Instructing you to pursue a claim against a third party before offering to pay your claim
  • The opposite happens: instead of dodging you, insurance adjusters constantly bug you for more forms or to discuss repeatedly issues that have already been resolved.

Why do HMOs and Insurance Companies Commit Insurance Misconduct?

The insurance industry is based on the laws of probability. They figure the odds of any insurable accident happening, but they also diligently research the number of policyholders who will give up and go away if they deny claims out-of-hand. Their probability (or actuarial) tables tell them how many policyholders don’t dispute arbitrary acts and just settle for what they offer and how many are willing to take the matter all the way to trial. This is why insurers benefit financially by routine underpayment of legitimate claims. They’re playing their game and do it with your money. If 10 out of every 100 fight them successfully and the other 90 take only what they’re offered, they win in the long run.

Each time you send in insurance premiums, you hold up your side of a contract in the expectation that you will be fully covered when you file a medical claim with your health insurer or HMO. Insurance companies and their policies can be intimidating and confusing. Sometimes people feel it’s easier to go along with the substandard compensation offer. But if you don’t stand up for your rights, you will lose the rightful compensation you deserve, that you paid for and that you probably can’t afford to be without.

Policyholders have two options if they are forced to deal with bad faith insurers: give up or take civil action. They can attempt to negotiate a settlement with the insurer themselves. But insurance companies look to benefit their own interests, which is keeping the money.

Do You Accept What the HMO Gives You or Do You Fight?

The other option when denied your full and rightful claim is to take all documentation and visit a qualified Cook County insurance attorney who understands this very specialized field of law.

The initial consultation with Buttafuoco and Associates is complimentary. Our attorneys will review the policy, the facts surrounding your problem with the insurance company and determine if the insurer is dealing in bad faith. One of the benefits of hiring a seasoned lawyer is that insurance companies often take your claim more seriously and could fulfill their contracted obligations in hopes that your case won’t end up in court.

If you think your insurance company has committed HMO insurance misconduct, Buttafuoco and Associates experienced bad faith insurance attorneys offer a free consultation. Contact us anytime by calling 1-800-NOW-HURT.