I understand how frustrating insurance companies can be; if your family member had health insurance, why can't they use it? Unfortunately, insurance claims aren't straightforward. Here's a look into why your deceased's claim was denied and what you can do about it.
Possible Reasons Your Deceased's Claim Was Denied
- The insurance company made an error
- The patient was treated out of network
- There's information missing
- A subrogation clause exists
The Term You're Looking for is "Subrogation"
Many health insurance providers have a subrogation clause in their contracts. Essentially, this means that if someone is injured in an accident and there's another form of insurance that could possibly cover the medical bills, then that other insurance should pay instead.
For example, if a pedestrian was hit by a car and broke their leg, the driver's insurance is technically "available" to pay for the pedestrian's medical bills. Due to the subrogation clause, the hurt pedestrian is required to make a claim against the driver's insurance policy rather than their own health insurance policy.
What Does Subrogation Have to Do with My Deceased Family Member?
In situations where the patient's injuries were so severe that they die as a result of the accident, subrogation can still occur. Essentially, this means that the patient's health insurance company will refuse to pay the medical bills of their deceased because there's another form of insurance present.
For the family (you), this means that in order to get the deceased's medical bills paid, you'll need to file a wrongful death claim against the at-fault party's insurance.
At this point, I'd advise you to consult with a wrongful death attorney who can help you sort through the insurance claims process and ensure that you receive compensation on behalf of your family member.
Making a Wrongful Death Claim in Texas
In Texas, the family member of the person deceased has the right to pursue compensation for pain and suffering, financial expenses, medical expenses, and other types of compensation. Many times, family members can be left with dealing with expenses associated with the car accident damages, emergency services, and other high-cost services. Personal injury attorneys are specialized in fighting for the deceased's family in representing them against the at-fault person's insurance company. Even more, the legal terminology that the insurance companies use can be meant to confuse or trick victims into having their claims rejected or by offering a low amount of settlement. The attorneys at the Anderson Law Firm not only have substantial amounts of experience in fighting insurance companies, we also have the best reputation for fighting for our clients' rights.
If you have had a loved one who passed away as the result of a car accident, contact the Anderson Law Firm today for a free no-obligation consulation. Our legal professional team is more than ready to answer any of your questions regarding a possible case, so give us a call today at 817-717-4731!
Other Articles You Might Be Interested In:
Medical Liens and Subrogation
Making A Wrongful Death Claim on Behalf of Someone Who Has Died
Why do I have to pay back my health insurance company?