Can I sue an insurance company for denying a valid claim

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Can I sue an insurance company for denying a valid claim

I applied for coverage
with their supplemental
insurance company in
December 2016 my
coverage took effect on
01/07/2017. I had an
MRI and x-rays on the
16th of the month which
resulted in needing
surgery . My claim was
denied as pre-existing
because I saw a doctor in
November for neck pain.

Asked on April 13, 2017 under Insurance Law, New Hampshire

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

Yes, if you believe that the insurer is not honoring their contractual obligation (an insurance policy is a contract), you can sue them for "breach of contract" for the money which they should have paid. To prevail in court, you would have to convince the court by a "preponderance of the evidence" (that it is "more likely than not") that under the terms of the policy (since like any contract, an insurance policy is enforced in accordance with its plain terms) and facts of the situation, that they should have paid. Bear in mind that you cannot recover any legal fees, if you sue: you will have to pay these yourself.


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