What is a Bad Faith Insurance Claim?

bad faith insurance

If you have health insurance, it is reasonable to expect that your health insurance company will act in good faith when processing your health insurance claims or a request for care that is covered under the insurance policy. When a policyholder is denied much needed health care, there can be terrible consequences including progression of an illness. When a health insurer acts in bad faith, the policyholder may be able to recover damages through a civil lawsuit.

Bad faith insurance is when an insurer attempts to back out of its obligations to its policyholders. A health insurance company may have acted in bad faith if they:

  • Denied coverage for legitimate health care claims or a request for care covered under the health insurance policy.
  • Failed to respond to a claim or request for service in a timely manner.
  • Refused to investigate / settle a conflict.
  • Failed to investigate a claim appropriately.

What is a bad faith insurance claim?

The purpose of a bad faith insurance claim is to hold the insurance company accountable for the harm caused by failure to meet their obligation to a policyholder through a personal injury settlement. A bad faith insurance claim is a type of civil lawsuit, which means it is best handled by an experienced local personal injury lawyer who can help you navigate your case.

A personal injury attorney will handle all aspects of a bad faith insurance claim, including:

  • Reviewing the insurance policy to ensure that the patient followed the policy’s requirements for receiving treatment such as seeking a referral from a primary care physician.
  • Reviewing the insurance policy to ensure that the patient received care at a health care facility covered by the insurance policy and that the care requested should have been covered by the insurance policy.
  • Gathering all paperwork showing requests for care, claims sent to the insurer and denial letters sent from the insurer.
  • Ensuring that every opportunity to file an appeal has been taken. Essentially, this means that each time a denial letter was received that the patient or medical care provider filed an appeal with the insurer asking for reconsideration.

A successful bath faith insurance claim will recover damages for pain and suffering, lost wages, disability, loss of consortium, and more.

Woman denied mammogram because she was “too young” and lacked a family history

In a recent story reported on, a 29-year-old California woman was twice denied a mammogram due to her young age and lack of family history despite the fact that she had a near marble-sized lump in her breast. Eight months later the lump had grown “eight centimeters into my left breast and was very bothersome.” At that time, she was given an emergency mammogram and ultrasound. The next day she was sent for an emergency PET scan and MRI and underwent eight biopsies. Ultimately, she was diagnosed with stage 4 breast cancer that had spread to her lungs, lymph nodes, and sternum. She was immediately put on six rounds of chemotherapy. She is now 35-years-old and will likely have to do chemotherapy treatments from time to time for the rest of her life.

According to the Centers for Disease Control and Prevention, approximately 9% of all new breast cancer cases in the U.S. are in women under 45-years-old. When insurance companies deny a legitimate request for cancer screening because a woman is under 45-years-old, they may be putting their policyholder at risk for preventable death or disease progression that makes invasive treatment necessary.

The Seattle Personal Injury Lawyers You Want on Your Side

The personal injury attorneys at Tinker Law Firm have been winning birth injury, medical malpractice, and personal injury cases for individuals and their loved ones in Seattle and across Washington State since 1974. We seek justice for injury victims who have been harmed by preventable medical errors, and the negligent or abusive actions of another. Our clients pay no fees or expenses to file a personal injury claim; our firm advances out-of-pocket expenses and is only reimbursed when we recover a settlement on your behalf. Do not delay; personal injury claims in Washington State have a statute of limitations, which means they must be filed within a certain time from the date of the injury.

Call us now at 206-842-1000 or contact us online to schedule a free consultation with one of our skilled and experienced injury attorneys.