Facing an insurance claim issue can feel like you are up against a giant maze of paperwork and red tape. You might have been counting on your insurance to help you through a difficult time, only to find yourself facing unexpected hurdles and delays.
It is a situation many people find themselves in, and it can feel overwhelming when you are already juggling other stressors. Our San Jose insurance lawyers understand what you are going through because we have been there, helping countless clients in San Jose navigate these troubled waters.
Our San Jose insurance lawyers are here to cut through the confusion. We know the system, and we know how to fight for your rights. With us by your side, you can focus on what truly matters—your health, your family, and your peace of mind. Let us handle the complexities and advocate for you so you can get back to focusing on your life.
Contact us at 408-539-0081 for a free consultation.
Types of Cases We Handle
Our firm competently handles a wide range of insurance disputes, including:
Federal ERISA Matters
If your employer-sponsored insurance plan is governed by ERISA (the Employee Retirement Income Security Act), we can help. We handle cases involving denied claims, wrongful terminations, and other ERISA-related disputes, ensuring that your rights are protected under federal law.
Insurance Bad Faith Claims
Sometimes insurers do not live up to their end of the bargain. If you suspect that your insurance company is acting in bad faith—by unfairly denying your claim or delaying payment—we are ready to step in. We fight to hold insurers accountable and get you the compensation you are owed.
Long-Term Care Insurance
Long-term care insurance should ease the burden of paying for extended care services. If your claim has been denied or your benefits have been unjustly reduced, we will work to make sure you get the coverage you need.
Life Insurance Claims
Dealing with the loss of a loved one is tough enough without having to fight for life insurance benefits. If your life insurance claim has been denied or delayed, our team will advocate for you, ensuring that you receive the benefits your family deserves.
Long-Term Disability Claims
If you are unable to work due to a long-term disability and your insurance claim is denied, we are here to help. We will navigate the complexities of disability insurance and work to secure the benefits you need to support yourself and your family.
Health Insurance Claims
Health insurance is supposed to cover necessary medical treatments, but sometimes insurers deny claims unfairly. Whether it is a dispute over coverage or a denied claim for essential treatment, we are here to advocate for you. We understand the importance of timely and adequate healthcare and will work to secure the coverage you need.
Common Tactics Insurance Companies Use to Reduce Claims
When you are dealing with an insurance claim, it can often feel like the odds are stacked against you. Insurance companies, while seemingly supportive in their advertisements, can become formidable opponents when it is time to pay out a claim. Here are some common tactics to be aware of:
Denial of Claims
One of the most straightforward tactics is outright denial. Insurance companies often find small discrepancies or technicalities to justify not paying out a claim.
Requiring Unnecessary Documentation
Another common strategy is to ask for an overwhelming amount of documentation, some of which may not even be directly relevant to the claim. This can be exhausting and confusing, deterring many from pursuing their claims fully.
Misinterpreting the Insurance Policy
Sometimes, the language in insurance policies is used against policyholders. Insurers might interpret the wording in ways that minimize their responsibility to pay.
Surveillance and Privacy Invasion
Some insurers use surveillance to undermine your claim. They might watch you to see if your actions match your reported injuries.
Why Are Insurance Claims Denied?
Dealing with insurance claims can feel like a tug of war. Often, you do everything right, yet your claim still gets denied. Here is why this might happen:
- Missing Information: One of the most common reasons for denial is missing information. Insurance companies require specific documents and details to process a claim. If you leave something out, even by mistake, your claim might get denied.
- Pre-existing Conditions: Insurance companies often deny claims based on pre-existing conditions. They might argue that your illness or injury existed before your coverage started. This is a frequent issue with health and disability insurance claims.
- Policy Exclusions: Every insurance policy has exclusions – specific conditions or situations that are not covered. For example, some health insurance policies do not cover certain treatments. If your claim falls into one of these exclusions, it can be denied.
- Administrative Errors: Sometimes, claims get denied due to simple administrative errors. A typo, incorrect date, or misfiled document can lead to a denial.
- Failure to Meet Deadlines: Insurance companies have strict deadlines for filing claims and appeals. If you miss a deadline, even by a day, your claim can be denied.
- Fraud or Misrepresentation: If the insurance company believes you have provided false information or misrepresented facts, they can deny your claim. This is why it is essential to be honest and accurate in all your communications.
What to Do After an Insurance Claim Denial in San Jose
Getting an insurance claim denial can feel like a punch to the gut. After all, you have paid your premiums and expected support when you needed it. Here is what you can do if you find yourself in this situation in San Jose:
Receiving a denial on an insurance claim can be disheartening, especially when you are counting on those benefits. However, a denial is not the end of the road—there are several steps you can take to challenge the decision.
First and foremost, do not panic. Take a deep breath and carefully review the denial letter. Insurance companies are required to provide a reason for denying your claim, and understanding their rationale is crucial. Look for any specific points or terms mentioned, as this will be your starting point for building your case.
Once you understand why your claim was denied, gather all relevant documentation. This includes your insurance policy, correspondence with the insurance company, medical records, bills, and any other evidence that supports your claim. Having a complete and organized file will make it easier to present your case clearly and effectively.
Next, contact your insurance company and request a copy of your “claim file.” A “claim file” is a collection of documents and records that an insurance company maintains related to an ERISA claim. When a claim for benefits is filed, the insurance company compiles all the information it uses to make decisions about the claim, including medical records, correspondence, internal notes, policy details, and other evidence it considers in approving or denying the claim.
If your initial efforts to resolve the issue with the insurance company are unsuccessful, contact us before you file an appeal. Most insurance policies have an appeals process, and it is important to follow it meticulously. Submit a formal appeal letter, clearly outlining why you believe the denial was incorrect, and include all the supporting documentation you have gathered. Be sure to meet any deadlines specified in your policy to avoid losing your right to appeal.
Throughout this process, keep detailed records of all your interactions with the insurance company. Note the dates, times, and names of the representatives you speak with, as well as summaries of your conversations. This information can be invaluable if you need to escalate your claim further.
Our experienced insurance lawyers can provide invaluable assistance, helping you understand your rights, building a strong case, and advocating on your behalf.
Why Choose Kantor & Kantor?
At Kantor & Kantor, we understand that dealing with insurance claims can be complex. That is why our team is dedicated to making the process as straightforward and stress-free as possible for you. We are not just lawyers; we are people helping people, and we genuinely care about making a difference in your life.
Our team has years of experience navigating the tricky waters of insurance law. We have seen firsthand how insurance companies work to protect their interests. We use this knowledge to get you the results you deserve.
With countless victories in insurance law cases, our attorneys know the ins and outs of insurance law. We have successfully handled all types of insurance claims, from health and disability to life and long-term care. Our track record speaks for itself, and we are proud to have recovered millions of dollars in benefits for our clients.
What truly sets us apart is our commitment to our clients. We believe in personal attention—when you work with us, you are not just another case file. We take the time to understand your specific situation and tailor our approach accordingly. We are here to listen, to understand, and to fight for you.
And when it gets tough, we do not back down. We are ready to stand up to big insurance companies and are not afraid to take your case to court if that is what it takes to get a fair resolution. Our goal is to ensure you receive the benefits you are entitled to, and we work tirelessly to make that happen.
How We Can Help
When you are up against an insurance company, it can feel like you are navigating a complex maze alone. That is where we step in. At Kantor & Kantor, we bring a human approach to your legal challenges, treating each case with the care it deserves. Here is how we assist you.
1. We will Hear Your Story
The first step in handling your insurance case is listening to your story. We want to understand what you are going through, how the insurance company’s actions have affected you, and what you hope to achieve. This is not just about gathering facts—it is about connecting with you on a personal level and showing you that we genuinely care about your well-being.
2. We Will Review Your Policy Thoroughly
Insurance policies can be incredibly complex and filled with confusing legal jargon. We will carefully review your policy to understand what coverage you have and what benefits you are entitled to. Our goal is to uncover any potential avenues for your claim and ensure that we have a solid understanding of your rights under the policy.
3. We Will Gather Strong Evidence
To build a compelling case, we need strong evidence. We will help you gather all the necessary documentation, such as medical records, expert opinions, and any other relevant information. Our team knows what evidence is most persuasive and how to present it in the best possible light.
4. We Will Build a Strong Case
With the evidence in hand, we will craft a compelling case to present to the insurance company. Our team knows the tactics insurers use to delay or deny claims, and we are prepared to counter them with facts and a clear narrative. We will highlight the critical points and make a strong argument for why your claim should be approved.
5. We Will Negotiate on Your Behalf
Our experienced lawyers will handle all communications with the insurance company, advocating on your behalf. We aim to resolve your case through negotiation, securing the benefits you deserve without the need for prolonged disputes.
6. We Will Take Legal Action if Necessary
If the insurance company continues to deny your rightful claim, we are prepared to take legal action. Our team has extensive experience in insurance litigation and will represent you in court if needed. We are committed to fighting for your rights and ensuring that justice is served.
Contact Our San Jose Insurance Lawyers Today
We know dealing with insurance issues can feel like you are fighting an uphill battle, especially when you are already going through a tough time. At Kantor & Kantor, we are here to make that fight a little easier. Our San Jose insurance lawyers are not just experts in the law—they are people who genuinely care about helping you get the benefits you are entitled to.
Our insurance lawyers are here to take the weight off your shoulders, fighting to ensure you receive the benefits you rightfully deserve. We believe in making the legal process as clear and stress-free as possible so you can focus on what is most important: your recovery and peace of mind.
Contact our San Jose insurance lawyers at 408-539-0081 for a free consultation.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
