Health Insurance is now denying new claims for an unrelated accident in early 2015

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Health Insurance is now denying new claims for an unrelated accident in early 2015

My health insurance is currently not paying a claim for a current problem, because of an unrelated car accident in early 2015. I was a passenger in a vehicle where someone else was at fault. They are claiming that they can randomly deny claims even if they do not pertain to that accident until I fill out a 3rd party questionnaire.

I received a small settlement just between me and the auto insurance carrier of the responsible party in early 2017. I stopped any treatments for the injury before then as they proved unhelpful. Eventually the injury returned to normal.

Now, I have a doctor’s office asking about my insurance not paying this new claim – which has nothing to do with what happened almost 4 years ago.

This questionnaire I was directed to wants me to SIGN A LIEN – which makes it seem like they can come after me for the settlement plus interest. This is very scary – what do I do here? I feel like my health insurance is blackmailing me into giving them legal recourse to try to take all my money – and then some – away from me simply because something happened that was not my fault at all.

Help

Asked on November 2, 2018 under Insurance Law, California

Answers:

M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 2 years ago | Contributor

First, on the denial there should be something that tells you the appeal process.  Follow that to the "T" and send it in asap.  Then, file a complaint with the California Department of Insurance. It can be in letter form and explain the situation in detail. Send in all the paperwork including the original denail and the appeal as well as the questionnaire.  It sounds like what they are doing is over reaching under the law.  Good luck. 


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