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Joseph, Lawyer
Category: Legal
Satisfied Customers: 5299
Experience:  Attorney with significant and substantial experience in multiple areas of law.
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Resolved Question:

Submitted: 2 years ago.
Category: Legal
Expert:  Joseph replied 2 years ago.
Hello and welcome to JustAnswer

I'm sorry to hear about your situation and hope I can help.

My name is XXXXX XXXXX my goal is to provide you with excellent service today.

I need a bit more information from you before I can proceed to provide you with a complete and thorough answer to your question.

It depends on what the basis of the suit would be. What was the coverage that was denied and for what reason?

Have you tried appealing the denial through the insurance company yet?
Expert:  Joseph replied 2 years ago.
Also, could you please write without all caps. It is a lot easier to read when you type without capslock on. Plus, it reads as if you are shouting when you use all caps.

Customer: replied 2 years ago.

Thanks. Basis of suit: failure of insurance company to pay my Illinois chiropractor's billings for services rendered to me in Illinois. They claim a "Licensed chiropractor" reviewed copies of his records and determined that none of the care was "medically necessary". However, they refuse to provide my provider with a copy of this alleged "Licensed chiropractor's" written report to refute/answer. Assurant Health claims that under Wisconsin Insurance Law they do not have to provide that information.


Coverage denied was for chiropractic care covered under this policy.


As a side note, they paid a similar claim a year or two ago.


Assurant Health in their denial material provides a process by which to appeal. However, in the past I have found this to be similar to a "kangaroo court". Besides, services were rendered in Illinois by an Illinois provider. Since Time/Assurant is licensed to do business in Illinois, one would think that this matter would be properly subject to Illinois Insurance Law-- not Wisconsin.


Thank you Joseph.

Expert:  Joseph replied 2 years ago.
Hello Brad,

Unfortunately, you are typically required to exhaust all administrative remedies at your disposal prior to filing suit, so you should definitely try to go through their process although it definitely appears to be a kangaroo court.

You would have a claim against the company for bad faith for failing to pay on the claim that is covered under your policy. You are also definitely correct that the policy should be interpreted under Illinois law, and Wisconsin, since the insurance company is located in Illinois and the service that you received was in Illinois.

With that information and a determination that the medical coverage was necessary (as it seems to have been a continuation of care you received in the past that was approved) you should be successful in your claim against Assurant Health.

I hope the above information is helpful.

Please let me know if you have any clarifying questions as I want to ensure that you are completely satisfied with my service. Definitely contact me if you are contemplating leaving me a negative rating, as I’ll be happy to continue to address your concerns until you are satisfied with my service.

If not, please remember to rate my answer positively so I get paid for my work. It is necessary for you to rate my answer even though you’ve made a deposit or are a subscriber. I only receive compensation for my work if you rate me positively. Otherwise, I receive nothing for assisting you, and the website retains your entire deposit.

Thanks and best of luck!

Joseph, Lawyer
Category: Legal
Satisfied Customers: 5299
Experience: Attorney with significant and substantial experience in multiple areas of law.
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