Carlsbad's Insurance Law Attorney
What does an Insurance Lawyer do?
Insurance is complicated. In any injury, there could be factors like Group Health, Workers Compensation, Medicare, Medi-Cal, your own private medical insurance, just to name some.
The function of an insurance lawyer, like Mark Caruana, is to coordinate all those benefits to maximize your recovery.
Major U.S. Insurance Laws & Decisions
Even though most insurance regulation in the United States happens at a state level, there are some significant pieces of U.S. insurance legislation. There are also notable court decisions. From initially ruling that insurance contracts are not commercial products subject to insurance regulation, the U.S. Supreme Court upheld federal insurance regulations in the 1944 United States v. Southeastern Underwriters Association case.
Affordable Care Act
The Affordable Care Act is actually two laws: the Patient Protection and Affordable Care Act
and the Health Care and Education Reconciliation Act of 2010. The laws expand Medicaid and other government health insurance programs. They create subsidies for private health insurance policies based on income and also create requirements for certain mandated coverage in private insurance policies.
Medicare, Medi-Cal, Military Liens
Each of these will require a right to reimbursement and there are issues than can be raised with each of them.
Good Faith
One of the key principles in insurance is the concept of good faith. Insurance as a contract and as a financial product only works when both parties are honest with each other and work to fulfill the terms of the contract based on the true facts of the situation. Failing to apply for an insurance contract in good faith is a form of cheating. Refusing to pay a fair claim is another form of cheating. The opposite of good faith is bad faith.
For example, a person applies for life insurance. They answer on the form that they don’t have any pre-existing medical conditions and that they have never been hospitalized. In fact, that isn’t true. The person was hospitalized last year with a serious illness. Five years later, the insured dies of the same illness.
The life insurance beneficiaries try to make a claim on the insurance policy. The insurance company refuses the claim and refunds the premium. The contract is null and void because the insured didn’t enter into the insurance policy in good faith.
An insurance company can also act in bad faith. They can refuse to pay good claims. When an insurance company doesn’t have a good argument for denying a claim, they can face administrative penalties as well as a lawsuit for failing to handle the claim good faith. The penalties they face are in addition to legal actions to force them to pay the claim according to the terms of the contract.