What Is a Bad Faith Insurance Claim and How Is Insurance Involved?

If you have health insurance, it is reasonable to expect that your health insurance company will act in good faith when processing your health insurance claims or a request for care covered under the insurance policy. You have the right to expect that they will fulfill the contract terms you signed with them for the premiums you’re paying.  

When you are denied much-needed health care because the insurer violated the covenant of good faith, you may experience serious and lasting harm. The proper diagnosis of dangerous conditions can be delayed. Existing conditions may worsen without treatment, leading to long-term care, disability, or even the wrongful death of your loved ones.   

When a health insurer acts in bad faith, the policyholder may be able to recover damages through a civil lawsuit. In this short guide, you’ll learn more about bad-faith insurance claims. You’ll find out what they are, how they work, and how a lawyer can help.

What Is Good Faith in Insurance and When Should You Make a Bad Faith Claim?

Most courts in the United States, including the courts in Washington, recognize an implied covenant of good faith and fair dealing (See a law dictionary definition in the link). 

When two parties are engaged in a contract, they are both expected to act to fulfill the agreement as intended without working to undercut one another. This is what is meant by good faith, though even courts find it difficult to define on a case-by-case basis. 

Bad faith claims occur when an insurer is accused of backing out of its contractual obligations to policyholders without cause. There are legal reasons to end a contract (these are usually spelled out in the contract and subject to law), but simply ignoring or reinterpreting provisions to achieve a preferred outcome is an attempt to undermine the contract—that’s the definition of bad faith.

A health insurance claim lawyer can present many different activities as bad faith. A health insurance company may have acted in bad faith if they:

• Denied coverage for legitimate health care claims or a request for care covered under the health insurance policy.
• Failed to respond to a claim or request for service in a timely manner.
• Refused to investigate or settle a conflict.
• Failed to investigate a claim appropriately.

How Bad Faith Claims Work

Bad faith claims usually start with a consultation with a lawyer. A lawyer will be able to give legal advice, explain how breach of contract laws apply to insurers, list what evidence you need, and analyze whether your claim is likely to succeed. A lawyer will also be able to start the court process by filing your claim.

After the claim has been filed, several things may happen. In some cases, the insurance company may seek to settle with you immediately. In these cases, the claim will end when your lawyers and the insurance lawyers agree on a settlement and have it approved by the judge.

The insurance company may also contest your claim in court rather than seeking a settlement. When this happens, your lawyers will act as your advocates in the courtroom. They will help you gather evidence before trial, prepare you for testimony, and provide other assistance.

Bad faith claims are an area of personal injury law, so lawyers will often work on contingency fees. This fee structure results in no legal fees for the client unless and until the case is won. Law firms take on the risk that the case will fail but are awarded a percentage of the judgment if they are successful in fighting for your claim.

A successful bath faith insurance claim will often recover punitive damages for pain and suffering, lost wages, disability, loss of consortium, and more. 

Examples of Bad Faith: Woman Denied Mammogram Because She Was “Too Young” and Lacked a Family History

In a recent story reported on people.com, a 29-year-old California woman was twice denied a mammogram due to her young age and lack of family history despite the fact that she had a near marble-sized lump in her breast. Eight months later, the lump had grown “eight centimeters into my left breast and was very bothersome.” At that time, she was given an emergency mammogram and ultrasound. 

The next day, she was sent for an emergency PET scan and MRI and underwent eight biopsies. Ultimately, she was diagnosed with stage 4 breast cancer that had spread to her lungs, lymph nodes, and sternum. She was immediately put on six rounds of chemotherapy. She is now 35 years old and will likely have to do chemotherapy treatments from time to time for the rest of her life.

According to the Centers for Disease Control and Prevention, approximately 9% of all new breast cancer cases in the U.S. are in women under 45 years old. When insurance companies deny a legitimate request for cancer screening because a woman is under 45 years old, they may be putting their policyholder at risk for preventable death or disease progression that makes invasive treatment necessary.

Discuss Your Situation with an Experienced Insurance Claim Lawyer in Seattle

The personal injury attorneys at Tinker Law Firm have been winning birth injury, medical malpractice, and personal injury cases for individuals and their loved ones in Seattle. We have worked to be Seattle’s Personal Injury Firm across Washington State since 1974. We seek justice for injury victims whose preventable medical errors and the negligent or abusive actions of another have harmed them. 

Our clients pay no fees or expenses to file a personal injury claim; our firm advances out-of-pocket expenses and is only reimbursed when we recover a settlement on your behalf.  Do not delay; personal injury claims in Washington State have a statute of limitations, which means they must be filed within a certain time from the date of the injury.

Call us now at 206-842-1000 or Bad Faith Contact Form to schedule a free consultation with one of our skilled and experienced injury attorneys.