Healthcare coverage is not created equal. Depending on your type of healthcare coverage, you are entitled to certain protections under the law. Here is a primer to help you understand your type of healthcare policy or plan:
These are insurance policies which you buy as an individual or family. These policies are not provided through employment. In many states (including California), an insure may be liable for bad faith damages (such as punitive damages, financial distress damages, emotional distress damages, and attorney's fees) for failing to promptly pay or investigate your insurance claim.
These health plans are created by employers for the benefit of their employees and families. They may be funded by the employer (aka "self-funded") or insured through an insurance policy purchased by the employer. Either way, the plans are governed by ERISA (Employee Retirement Income Security Act of 1974) which sets forth the requirements for such plans. Bad faith damages are not applicable to ERISA plans. However, ERISA does permit claimants to pursue a federal lawsuit to recover benefits owed, interest, and attorney's fees. ERISA does not apply to governmental entities (see next category). Claimants must exhaust administrative appeals before filing a lawsuit.
Other Self-funded Plans
These include all other plans which are not funded by insurance policies and the employer is a governmental entity such as a city or state. Because these plans are neither insured nor governed by ERISA, the participants do not have the protections of ERISA or insurance law. However, the plans may still be liable for breach of contract for failing to pay claims.
How Our Law Firm Can Help
Handling insurance and disability claims can be complicated, which is why Kantor & Kantor, LLP is here to provide counsel. As one of the most respected and experienced firms dealing with claims against insurance companies, we have the knowledge needed to take on your case. We have represented clients from all over the country with West Coast offices based in California, Oregon, Washington, and Nevada. Our lawyers are well known for their in-depth knowledge in taking on complex appeals and Federal Court litigation matters involving ERISA.
We know what to do so you don’t have to take on the fight alone. Our approach is structured, hands-on, and aggressive. It isn’t just knowing the law; it’s the courage to take the fight to the courtroom and it’s reflected in the results we achieved.
This is what makes Kantor & Kantor, LLP different. Our clients know what that difference has meant to them and their reviews show the confidence in our team was well-deserved.
We are The Client’s Advocate law firm.
We welcome you to check out our attorneys and staff to see for yourself what type of a team you will have in your corner!