Health Insurance Coverage

California Health Insurance

Denied Health Insurance Coverage?

Residents of California can be denied health insurance coverage for a variety of reasons. You may be denied coverage after reaching a maximum coverage amount due to an illness or treatment. You may be denied because of a lack of continued eligibility or even a change in job position that renders you ineligible for sustained coverage. Whatever the reason, being denied coverage can make paying for a long term illness or condition next to impossible for many Californians.

Your health insurance claim in California can be denied for a myriad of reasons. One of the most common reasons given, however, is labeled as "material misrepresentation." This is a term used whenever an insurance company deems that you have misrepresented some fact or facts on your initial or renewal application. Under California law, this error has to be something that is significant enough that it would have led the insurer to refuse your policy originally.

Typical examples of material misrepresentation include unreported or underrepresented levels of tobacco or drug use, the exclusion of a chronic medical condition, dangerous hobbies, piloting, skydiving, or a history of reckless driving. 

You cannot be denied for simple misstatements, however. For example, if you say you have green eyes on your application and the insurance company lists them as "hazel," your claim cannot be denied.

Health Insurance Coverage

At Kantor & Kantor, LLP, our attorneys have the skills, experience, and tenacity you deserve. Get to know our team by scrolling down and select the staff you would like to learn more about.

  • PLAY

California Health Insurance Laws

Recent changes in the California health insurance laws have made it much easier for claimants to get approval for the medical treatments they require. For example, California residents can now legally sue HMOs and other health insurance providers after being denied coverage for vital treatments. According to state laws, these companies have to be accountable for denials, and the legal system now provides an outlet for regular folks to take on huge insurers--and win.

Basically, the law requires HMOs and other health insurance providers in California to give you the right to a second opinion. Oftentimes, this may require that you go outside of your HMO network for proper treatment. Under old laws, you would be responsible for all or most of your treatment costs outside of your network provider. However, new laws allow you to sue your HMO to cover these costs when medically necessary. Even if you've been denied, you can legally obtain reimbursement in many cases.

Contact Us 

We Are Here To Help You

Learn more about our legal team and discuss the details of your case by completing our contact form or by giving us a call at (877) 220-0556 . Our consultations are free.

  • Please enter your first name.
  • Please enter your last name.
  • Please enter your phone number.
    This isn't a valid phone number.
  • Please enter your email address.
    This isn't a valid email address.
  • Please make a selection.
  • Please enter a message.