Legal Question in Insurance Law in California

Insurance sitting on claim for 3 years.

Almost three years ago, I had surgery due to an injury from an auto accident. My health

insurance (CIGNA PPO) has not officially denied the claim but they�re using one stall

tactic after another in not settling the claim. These are mainly claims of their not receiving

copies of my medical records. Which did happen over and over but only because they kept

sending their requests to the wrong address. Each time, I stepped in and arranged for

them to get the copies. So now, they�ve had for almost a year copies of every record from every

physician/hospital involved. But now they're demanding copies of records that don�t exist. They�ve officially �closed� the claim based on not having received a copy of a neurological report on a CT scan. The CT scan (which they have a copy) was

negative so there is no neurological report. The ER record (which they have) states that the CT scan was negative. What can I do to make them settle this claim?

Also, I spent almost $500 in collecting and sending them the medical records they requested. I�ve requested reimbursement from them twice (providing full documentation)with no response or acknowledgement. What can I do?


Asked on 11/04/00, 12:27 pm

2 Answers from Attorneys
Steven Murray Steven W. Murray, APC

Re: Insurance sitting on claim for 3 years.

Have you paid for these expenses and are now seeking

reimbursement from CIGNA? If not, haven't the

doctors/etc. obtained payment from CIGNA? Or is

your question how to get back the $500?

Please advise - it makes a difference as to the

better tactic to take.

And, what about your accident? Did your auto insurer

pay for these with your med pay coverage? Did you

have a recovery from the defendant?

Read more
Answered on 11/17/00, 8:20 pm
John Hayes The John Hayes Law Offices

Re: Insurance sitting on claim for 3 years.

From what I gather from your question you were in an auto accident three years ago. Your medical insurance company has been neglecting to pay your medical bills for almost a year and you have spent $500 out-of-pocket for your medical records. If I have this right, you may have a claim for insurance bad faith, but I cannot be sure without additional information. Hopefully, you have settled your personal injury claim for the accident and have the amount of the medical bills set aside to reimburse your medical insurance company once they have paid. Again, hopefully you know that if your insurance company pays the bills they will be significantly reduced and therefore will significantly reduce the amount you have to reimburse. If this is the case, a stern letter from an attorney may do the trick in getting them to pay these medical bills before they go to collections as a bad debt and therefor listed on your credit report. If this is not the case than you really need to speak with an attorney immediately. I offer a free, no obligation consultation. You can reach my office by phone, toll free at 877-546-9918, or by email at [email protected]. If you do not take me up on my offer, please contact an attorney before you end up getting sued by your insurance company for failure to reimburse them for medical bills they may pay.

I look forward to speaking with you, and I wish you the best of luck if I don't hear from you.

Sincerely,

Dr. John Hayes

Read more
Answered on 11/18/00, 7:59 am


Related Questions & Answers

More Insurance Law questions and answers in California