Legal Question in Insurance Law in Louisiana

Insurance company responsibility

I switched insurance companys in Octobre 2006. My old policy ran to the end of December and my new plan started on January 1st. I injured my Biceps tendon on Dec. 8 2006. The old insurance company said that they are not responsible for any bills past 12/31/06. The new Insurance said it is pre-existing and are not responsible. Can you tell me if the old company is responsible.

Asked on 1/03/07, 11:20 am

1 Answer from Attorneys

J.Clayton Davie, Jr. Davie & Davie, LLC

Re: Insurance company responsibility

The actual terms of the respective policies control the relationship and respective obligations of the parties. Consequently, without having an opportunity to review the policy terms and conditions, a proper evaluation can not be made. However, you should be aware of the the fact that ordinarily, unless clearly and expressly excluded under the terms of the old policy, medical expenses attributable to a covered injury sustained during the policy period will be covered even though those expenses are incurred after the policy expires. Closely review your old policy for terms that clearly and unambiguous state that the insurance companies duty to pay ceases upon the expiration of the policy. If no such language is contained in the policy, bring this to the attention of the insurance company with the admonition that you consider their misinterpretation of their own policy to constitute bad faith or alternatively, that the policy is ambiguous as a matter of law and will be construed against the drafter and in favor of coverage.

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Answered on 1/04/07, 8:19 am

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