Legal Question in Insurance Law in North Dakota

Dental Insurance is denying claim wrongly

I was treated for what my dentist said was TMJ. My insurance claim booklet says that nonsurgical TMJ treatment

was covered under our plan. After i had the procedure done

my insurance company turned me down due to incorrect codes

being used. We resubmitted it a 2nd time and was denied

again for the same reason.

I contacted the person who deals with the insurance in my

company and they couldn't understand why it was being denied. In the mean time the insurance company decided they

were going to pay for splints that were designed for my

mouth but would not pay for the procedure to have my mouth

fitted for the splints(x-rays,muscle manipulation,tests of

all sorts. In the mean time the company closed down before

we were able to get this matter resolved. And now they are

filing judgement against us for $1100.00. Do we have a legalleg to stand on. Please advise.


Asked on 5/22/02, 8:12 am

1 Answer from Attorneys
Steven Murray Steven W. Murray, APC

Re: Dental Insurance is denying claim wrongly

Sue the insurance company for your damages, and include aggravation and possibly punitive damages.

Make sure you sue (1) the insurer, who actually wrote the policy/plan, and (2) the administrator/company who administered the policy/plan if there is one.

If you have additional patience, if there is an insurer and an administrator, then contact the insurer and complain about the company which is handling their affairs. This is probably what your situation is, since most insurers don't just close down in contrast to many third party administrators.

Read more
Answered on 5/22/02, 9:33 pm


Related Questions & Answers

More Insurance Law questions and answers in North Dakota