For those out there who are going to be newly insured in the new year, or those that hope to be soon, you should be aware that both state and Federal law give you rights if the insurance company fails to live up to its obligations (and they most likely will disappoint you if you have a significant claim). New Jersey has an appeal procedure for any denied claim and that includes review by an independent third party, but you also have the right to enforce your insurance contract in court. At the end of it all, insurance is a contract. In exchange for paying your premiums, the insurance company agrees to accept the risk of paying your medical bills. If they fail to do so, they are in breach of contract. Employer provided insurance is also governed by Federal Law, primarily by a statute known as ERISA.
Now that the Affordable Care Act (also known as “Obamacare”) mandates that every person have insurance, more people will be subjected to denials of coverage that have no basis in fact. When this happens, it is important to protect your rights, and your wallet.
We have successfully handled several cases where the insurance companies wrongfully denied health care claims. Call 201-289-5352 if you have any problems with your insurance company.