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Ely
Ely, Counselor at Law
Category: Legal
Satisfied Customers: 86621
Experience:  Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
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I found out about six months ago that I was being over charged

Resolved Question:

I found out about six months ago that I was being over charged by my group health insurance. The Insurance company knew it because I also had medi-care which paid all my medical bills first. After researching I found that they have been overcharging me for 10 years, which added up to $21,000. This seems like a lot but they saved hundreds of thousands over the years. My previous employer said they should refund me, but when they didnt I wrote to the ins. co. several times. They claimed they would let me know, but so far nothing.
Any ideas?
Kathy
Submitted: 1 year ago.
Category: Legal
Expert:  Ely replied 1 year ago.
Hello friend. My name is XXXXX XXXXX welcome to JustAnswer. Please note: (1) this is general information only, not legal advice, and, (2) there may be a slight delay between your follow ups and my replies.

I am very sorry for your situation. When you state "overcharged," can you please tell me more about exactly what you mean? As in, they charged you a co-pay more than what the insurance contract stated, or, how exactly was the fraud executed?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. Thank you in advance.
Customer: replied 1 year ago.


Iam retired. My previous employer deducts a monthly amount to pay for my group health insurance. Currently it is about $300.00 per mo.

Expert:  Ely replied 1 year ago.
Thank you, K.

Someone in your situation may have a cause of action here in civil court.

To sue in a state court, one needs to have a "cause of action." There are numerous causes of action, such as "breach of contract," "negligence," "fraud," "unjust enrichment," etc., as well as causes of action rooted in statutory law. Every state has their own although they are very similar to each other in every state. Every cause of action has its own elements, and each element has to be satisfied for a cause of action to be successful in court.

Here, this may be actionable under the following:

UNJUST ENRICHMENT: The elements of an unjust enrichment claim are the "receipt of a benefit and [the] unjust retention of the benefit at the expense of another." Lectrodryer v. SeoulBank (2000) 77 Cal.App.4th 723, 726 [91 Cal.Rptr.2d 881].

MONEY HAD AND RECEIVED: closely related to unjust enrichment, this is a cause when money is held by someone that should in all equity be given back to you.

FRAUD: The elements of a cause of action for fraud are: (1) misrepresentation, including a misrepresentation of law, if such misrepresentation includes by implication a misrepresentation of fact; (2) knowledge that the representation is false; (3) intent to defraud; (4) justifiable reliance; and (5) resulting damage. Schultz v. Harney, 27 Cal. App. 4th 1611 - Cal: Court of Appeal, 2nd Appellate Dist., 3rd Div. 1994 (internal citations omitted).

You may wish to retain counsel as quickly as possible to consider an action. May I recommend the CA Bar referral program - here. The attorneys are vetted and qualified. You should be able to find an attorney you are confident with and whom you can trust, and who is available ASAP.

There is a statute of limitations that attaches, but it may be tolled if one can show that they did not reasonably become aware of the fraud until later on.

I hope this helps and clarifies. Best of luck.

Gentle Reminder: Please use the REPLY button to keep chatting, or RATE my answer when we are finished. Kindly rate my answer as one of the top three faces and then submit, as this is how I get credit for my time with you. Rating my answer the bottom two faces does not give me credit and reflects poorly on me, even if my answer is correct. I work very hard to formulate an informative and honest answer for you; please reciprocate my good faith. (You may always ask follow ups at no charge after rating.)
Ely, Counselor at Law
Category: Legal
Satisfied Customers: 86621
Experience: Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
Ely and 16 other Legal Specialists are ready to help you
Expert:  Ely replied 1 year ago.
Thank you for your generosity.

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