Consumer Protection Law
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Denial of a claim because surgery was not done in 90 days, when the plan states such surgery is covered, is likely to be deemed a bad faith denial when the claimant was under continuous medical care for the covered injury. You need to send them a letter informing them that you have been under continued care of a licensed medical professional and surgery was a "last resort" treatment and it has now come to that. Tell them in the letter that their denial of the claim for not having surgery in 90 days when the policy does not state that is a bad faith denial of your claim and if they refuse to reconsider and approve the claim, you will be forced to sue them for breach of contract in bad faith and seek your damages plus punitive damages and attorney's fees for their bad faith denial of your claim. If they refuse your appeal, then you have a basis (presuming the contract does not say surgery has to be performed in 90 days from claim) to file suit against them and seek damages from them for their breach and bad faith.