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Bellevue Washington Insurance Law Blog

Denied claim leaves homeowner without a wall

Buying a house is about so much more than just securing a roof over one's head. When someone buys a house, he or she is actually buying a home. Washington homeowners also understand the importance of protecting their homes by purchasing homeowners' insurance. But putting down roots and cultivating family memories under the same roof for years on end is a lot harder when insurance companies refuse to help policyholders when disaster strikes. Here is just one example of how a denied claim can impact someone who needs help.

In 2013, a woman purchased a home that was originally built in the 1890s. Her fiance moved in with her in 2019, putting them and their children all in the same home. Although they had bright hopes for the future, those dreams were dashed when one day it felt as if an earthquake had hit their home. There were not natural disasters, but the back wall of their home had fallen off.

Insurance law: Securing disability benefits for mental illnesses

Mental illnesses are not always well understood or even easy to recognize. This makes it hard for Washington residents who cannot work because of their mental health problems. When it comes to securing Supplemental Security Income or Social Security Disability Insurance, those living with mental illnesses often face an uphill battle against insurance law.

The Social Security Administration does recognize mental illnesses as legitimate reasons for being unable to work. It even maintains a list of illnesses that it considers to be inherently disabling, including schizophrenia, depression and bipolar disorder. Like with physical disabilities, someone suffering from a mental illness has to show that it prevents him or her from working. It is also necessary to show that the condition is very likely to last for a year or longer.

Washington insurers fined for violating insurance law

Doctors spend years studying medicine and dedicate their lives to caring for patients. These medical professionals understand their patients' medical needs far more than any insurance company ever could, and yet those companies often interfere with people's access to treatment. This is sadly not uncommon, and three Washington insurance companies were even recently fined for breaking insurance law multiple times.

Two of the involved insurance companies -- Premera Blue Cross and its sister company LifeWise Health Plan of Washington -- were both fined for mishandling treatment preauthorizations and appeals from policyholders during 2018 and 2019. The fines totaled $100,000 and $50,000 respectively. The Washington Office of the Insurance Commissioner issued those fines after multiple consumers submitted complaints to the office.

Insurance company keeps denying claims for child's care

Insurance companies like to act as though medical treatments are more of an optional choice instead of the absolute necessity that they are. They clearly demonstrate this attitude by denying claims for patients who desperately need care. This not only puts a tremendous financial burden on people in Washington, but it also jeopardizes their health and financial situations.

One out-of-state family is unfortunately all too familiar with this. The family's 6-year-old son was born with Down syndrome and requires specialized behavioral therapy in the form of advanced behavioral analysis, or ABA. The goal of this therapy is to help him develop the necessary skills for him to one day be more independent.

Insurance company denied claim for squirrel damage

Buying a homeowners insurance policy is just smart when buying a home. Not only do these policies provide financial coverage for damage to a home, but they also give homeowners a much needed sense of security. If anything goes wrong, they have their insurance policies to fall back on. Unfortunately, insurance companies frequently exclude common sources of damage either explicitly or with broad, confusing terms, so when purchasing coverage, a Washington homeowner should be sure to familiarize him or herself with the policy. This can be helpful when there is a denied claim for something that should be covered.

An out-of-state family was recently told that their insurance company did not cover the extensive damage to their home. The family was on vacation when their home alarm went off, but neighbors who peeked through windows and doors reported that nothing seemed out of place. Chalking the alert up to a problem with the software they enjoyed the rest of their vacation.

Insurance law helps policyholders fight denied claims

It often feels like insurance companies deny claims without really considering the real life policyholders who submit them. Prioritizing profits over people just seems like an industry standard. But just because it is the standard does not mean that it is right. When an insurer violates the terms of an insurance policy by denying a valid claim, insurance law gives people in Washington the option to sue.

Insurance companies deny claims for all kinds of different reasons. Although those reasons can be valid when applied correctly, they are frequently used to deny valid claims that are actually covered. But an insurance company might say that it denied the claim because of a lack of coverage. Arguing that a policy excludes coverage for specific things, even if the terms are not really clear, is not uncommon.

Insurance law: How to approach homeowners insurance claims

It is impossible to anticipate whether a storm, fire or other disaster will damage or even destroy a home. Homeowners insurance coverage provides a sense of relief to most people because they know there is help should something happen to their homes. Unfortunately, insurance law makes this more complicated than it has to be. Insurance companies are often quick to deny claims they believe are not sufficiently justified or documented. Here are a few things Washington homeowners can do to better demonstrate the validity of their claims.

Contacting the insurance company might not be high on a person's list of priorities, but it should be. Ideally, homeowners should contact their insurance companies as soon as they possibly can. This is only the first step in the claims process, so there is no need to worry about not having every last bit of information on hand. One of the next steps should be to create a written inventory of property damaged or destroyed in the disaster. Doing so closer to the time of the disaster usually makes it easier to recall which items were involved.

Insurance law allows exclusions in life insurance policies

Reading the fine print of a life insurance policy is a good idea because it often spells out important details that can affect the rights of beneficiaries. Those details in one's policy may specify the exclusions, which are the circumstances under which the insurer can refuse to pay benefits. Understanding this critical element of insurance law can help Washington policyholders avoid leaving their loved ones with an uncertain future.

The purpose of a life insurance policy is to provide financial support for beneficiaries. However, if the death of the policyholder occurs under certain circumstances, such as while the policyholder is under the influence of drugs or alcohol, an exclusion in the policy may give the insurer the right to deny the claim. Other common exclusions include a death while committing a crime or death by suicide within the first two years of purchasing the policy.

How are homeowners associations and insurance law connected?

When purchasing a house, some people purposely seek out neighborhoods with homeowners associations. Others may prefer to settle down somewhere without an HOA, but limited housing opportunities in some areas of Washington might make it impossible to do so. In either situation, homeowners may need a more thorough understanding of how HOA bylaws and insurance law interacts.

HOAs provide both liability and hazard insurance for the neighborhood. In some situations, that insurance coverage may extend to residents' homes even if they have individual homeowners' insurance. HOAs can file claims for damage caused by a number of things, including broken water lines and storm damage. Claims for people's homes rather than shared community spaces are usually the result of widespread damage.

Insurance law bill would mandate hearing aid coverage for minors

Health insurance is supposed to help cover medical costs, which is exactly what patients expect when seeking care. Unfortunately, many patients also expect to fight their insurance companies over necessary specialists, medications and medical equipment. A bill proposing a change to insurance law could make it easier for some Washington parents trying to secure coverage for their children.

Even though hearing aids are usually associated with the elderly, people of all ages need help hearing for any number of reasons. For example, children may need hearing aids for genetic conditions or even serious conditions that affect hearing. Unfortunately, private insurance companies do not care why children need help hearing, because they refuse to classify hearing aids for children as medically necessary.