Several news outlets are reporting that California’s insurance commissioner has launched an investigation into Aetna after its former medical director admitted that he did not review patient records when making a decision to deny coverage for various medical procedures. CNN’s article about this shocking revelation and emerging scandal can be found here. The revelation came in a deposition in an insurance lawsuit arising under California law in Superior Court in Orange County, California. For those of us who represent participants in health and disability benefit plans, Dr. Jay Ken Iinuma’s admission that he did not review patient records in making medical necessity determinations is additional confirmation that many health insurance plans and disability benefit plans repeatedly, routinely, and wrongfully deny claims for benefits in violation of applicable laws and regulations.
All employee benefits plans covered by the Employee Retirement Income Security Act of 1974 (“ERISA”), including health insurance and disability benefits plans, are required to provide plan participants with a full and fair review of their claims for benefits. Likewise, individual health insurance policies that are not covered by ERISA are required to provide their participants with a full and fair review of their claim. In order to receive a full and fair review, an insurer’s claims personnel, including their medical directors, must review the participant’s relevant medical records before making a decision. Far too often, it is clear when a client’s claim has been denied that the insurer has failed to provide the claimant with a full and fair review of his or her claim.
If you believe your health claim or long term disability benefit claim has been wrongly denied, you should contact an experienced ERISA employee benefits lawyer or insurance lawyer without delay. Your right to appeal the denial will be subject to certain time limitations. At The Garner Firm, your initial consultation is always free. Contact us today, for your free consultation.
Adam helped me with my LTD case. His knowledge and thoroughness was outstanding. He communicated every aspect of the process and case in an extremely detailed and timely manner. He also took the time to answer any questions I had as a person going through it for the first time. I could not recommend him more for anyone in a similar situation.
Adam and his team are great. They did an excellent job helping my family when we were really losing hope. Adam is very professional and has excellent knowledge to protect your rights. If you choose Adam you will talk directly with him. It was a truly pleasant experience. I’m extremely thankful that I chose the Garner firm. I highly recommend them.
Adam Garner provided excellent courteous and considerate service in helping me resolve a long term disability claim. He was accessible, knowledgeable and exercised the good judgement necessary for us to be successful. I heartily recommend his expertise and services
This review is long over-due!
If you’re looking for professional and sound legal advice, The Garner Firm is where you want to start!
Throughout my relationship with The Garner Firm, there was never a time that I felt uninformed where my case stood. Attorney Adam Garner focuses on making sure his clients are well informed throughout their legal battle. I can reassure any prospective clients that Adam will maximize all his resources and fight to the MAX in order you’re reasonably compensated.
I invite you to take the opportunity to contact The Garner Firm – YOU WILL NOT REGRET IT!