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Texas ERISA And Bad Faith Insurance Law Blog

Lawsuit dismissed after credit union and insurer settle

Businesses and individuals in San Antonio rely heavily on their insurers to offer them coverage when unanticipated problems arise. That coverage is not in place to allow them to profit in any way, but to rather recover from whatever financial losses they sustain. While most people understand that insurance companies do not stay in business by paying out on every claim that crosses their collective desks, the expectation is still there that, absent any questionable circumstances, such providers will honor the stipulations of their contracts. When that does not happen, subscribers may be justified in alleging that their insurers are operating in bad faith. 

Such is the claim being made by a credit union in Alabama after its insurer failed to offer fidelity bond coverage as promised. The credit union lost over $7 million in bad loans made to a local businessman who has since been indicted and pled guilty to several fraud charges. Its current leadership claims those losses were due to poor lending practices allowed by its previous management team. The coverage it had secured through the insurance company was for compensation for losses due to the fraudulent actions of employees. However, its initial claims were denied, prompting the credit union to sue the insurer for bad faith refusal to pay and breach of contract. The sides recently reached a settlement, ending the suit. 

Fire insurance claims: what you should know and do

A house fire is an unexpected, frightening experience that can leave you feeling unsettled, confused, and with a deep sense of loss. These feelings may linger for weeks or even months after the actual event. The last thing you need is a struggle with the insurance company over getting the compensation you are entitled to. It’s no secret that insurance companies often look for excuses to deny claims or pay less than they should. What can you do to ensure that you get full coverage after a fire?

What if you are pressured to accept a partial payment?

Accidents, incidents, injuries or illnesses in San Antonio that require you to deal with insurance companies can be quite traumatic. Your desire, then, to have the whole ordeal over with is understandable. Unfortunately, insurers understand this, and will therefore often look for ways to try and encourage your frustration and worry in an attempt to take advantage of you. Thus, you can rest assured that the initial settlement you are offered is likely less than what you may be obligated to collect. 

Yet you are likely not an expert in insurance law or the claim review process. An insurance adjuster might try to overwhelm you with his or her knowledge, claiming that certain guidelines or regulations will inevitably prevent your claim from being paid in a timely manner, and that if you want to avoid any further hassle, you should simply take what is being offered. Understand that this is a ploy and remember to keep the following points in mind: 

  • Remember that your insurer will have access to records related to your claim, so do not try to embellish any facts and give it a reason to reduce or deny you coverage. 
  • Be careful what you say as you can be sure that the adjuster is recording everything said between the two of you. 
  • Do not accept any payment that is presented as a partial payment with the promise to receive more funds later. 

Appealing denied claims

As a healthcare provider in San Antonio, you no doubt feel a strong obligation to help your local patient population in any way that you can. Your ability to do that is, of course, dependent upon you being paid for the services that you render. Thus, when you receive an insurance claim denial, it is easy to become frustrated. Often, clients come to us here at The Law Offices of Jessica Taylor PLLC wondering what to do in the face of mounting denials. If you have the same question, it is important to understand that a denied claim does not need represent a final outcome.  

RevCycle Intelligence reports that as many as one in five claims are either denied to delayed. That rate can easily be felt in your clinic's bottom line given that patients will often not be able to afford to pay denied claim balances in a single lump sum. Therefore, your best bet to receiving swift reimbursement for your services is often to appeal insurer decisions. 

Why do I need a long-term disability insurance?

In an era where businesses all over Texas and throughout the U.S. are shifting more and more of the cost of insurance onto the shoulders of employees, it may seem that long-term disability is one of the benefits you can go without. You should consider this move from all angles, however, before making a final decision.

National Public Radio explains that long-term disability insurance can have a big impact on your lifestyle should you ever become disabled. These policies generally cover 50 percent to 60 percent of your normal income while you are unable to work due to accident or illness.

Who can receive benefits under COBRA?

If you are one of many Texans affected by job loss every year, your initial shock was likely followed quickly by fear of additional losses, including your benefits, home and maybe even your family. The uncertainty is a guarantee of sleepless nights and high stress levels for anyone. One thing that may give you a little ease is knowing that you do have an option for continued health benefits through the COBRA program.

Congress passed the federal Consolidated Omnibus Reconciliation Act in 1986 as a means of offering group rates for temporary health coverage to workers who lose or leave a job. The employer no longer helps pay for the premium, however, leaving you to pick up the entire monthly payment. The payment is typically several times the cost of premiums for covered employees.

Common mistakes when applying for ERISA benefits

The Employee Retirement Income Security Act (ERISA), enacted by the federal government in 1974, allows for those who become disabled and unable to work to receive long-term benefits. But applying for ERISA benefits is anything but a simple process; these are muddy waters to navigate, and just one mistake in the application process could jeopardize the entire claim.

What are some common mistakes that should be avoided when applying for long-term benefits under ERISA?

After the hurricanes: rebuilding homes, but with a challenge

When it comes to home repair, finding the right contractor can make all the difference between mediocre construction performance and an absolute dream home. Yet for countless Texas residents, this is likely the last task to check off the list. After hurricanes Harvey and Irma, many have struggled to find contractors to make basic and vital repairs to their homes.

The catastrophic damage the natural disasters caused is evident, but CNN Money explains exactly why construction is at such a shortage in the area. Some contractors and other experts in the field point out that there was a preexisting shortage of contractors in many parts of Texas. The reasons? According to CNN, the housing crisis a decade ago resulted in the loss of a lot of skilled workers; the fact that a large majority of construction workers have reached the age for retirement has also been a contributing factor. On top of this, less younger workers choose to go into the construction industry. But the seemingly largest issue running amiss is the number of foreign construction workers as a result of President Trump's immigration policies. The industry, CNN points out, depends heavily on foreign workers -- and with the current political climate, less foreign individuals are choosing to relocate to the US.

Is my retirement plan defined benefit or defined contribution?

It is a terrific form of compensation from employment you have if your employer provides for a retirement benefit. The difference between defined benefit and defined contribution is significant.

It can affect your future decision making with regard to your later years in retirement. It can also affect your decisions now on how to prepare for retirement.

How should business owners report damage after a disaster?

After a natural disaster, your business may face serious structural and property damage. These losses can quickly add up, and without insurance reimbursement you may find yourself in financial hot water. Unfortunately, even with proper coverage you run the risk of claim denial. How can you increase your chances of executing a successful insurance claim?

 

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The Law Office of Jessica Taylor, PLLC

The Law Office of Jessica Taylor, PLLC
14100 San Pedro Avenue
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San Antonio, TX 78232

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