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Legal Eagle
Legal Eagle, Lawyer
Category: Criminal Law
Satisfied Customers: 5335
Experience:  Licensed to practice before state and federal court
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I'm being investigated by aflac. I worked for orthopedic

Customer Question

Hello I'm being investigated by aflac. I worked for orthopedic doctor . When my son got hurt I lol my son to urgent care they didn't know really if it was broke or not
So I took him to the dr I worked for he looked at him did X-ray and looked at X-ray from patient first and then told me it's fracture once I new that I took him to an orthopedic that took our insurance . Now because my son had 3 fracture in 2 months aflac was suspicious and they contacted my job to verify claims . My job would they didn't have my son down for appt this was an under the table exam . So they wouldn't verify it they had no paper trail do now I'm being investigated as if it's a false claim . Meanwhile he saw three doctors which all verify other than my job in which I got fired for because o wrote the letter stating the date my son came in and what he was treated for . My therapeutic is the de didn't dictate so now that insurance is asking and he knows he hasn't to dictate for everyone and didn't he's denying the claim what can I do . Do I need a lawyer
Submitted: 1 month ago.
Category: Criminal Law
Expert:  Legal Eagle replied 1 month ago.

Hello! I am a licensed attorney, admitted to practice in state and federal court. I have a nearly 100% satisfaction rating so all that means is that you can count on me to help today. I am very sorry to hear about your situation. This appears to be a violation of the implied covenant (promise) of good faith and fair dealing. Under the Uniform Commercial Code Section 1-304, every contract comes with implied promises from both parties that they are going to be acting fairly toward one another. The failure of one party to act fairly toward the other can result in a breach of contract. Specifically, insurance carriers are required to approve or deny claims in good faith. In your case, a lawyer should argue that it is entirely reasonable that you would take your child to the doctor with whom you worked, particularly if this was within the field of expertise of your employer. Just because the doctor did not dictate the exam does not mean it did not happen. Thus, it is not a reason to deny your claim. You may want to file a lawsuit against your insurance company and then compel your former employer to tell the truth under oath. To facilitate your situation, there’s a site that I’ve used in the past where you can find a good template for advising of a breach of contract (click here). It's a bit easier (and cheaper) than going through litigation and I have seen it be effective in the past. If you send this letter and they do not respond, then you may want to consider bringing a lawsuit after that because it will be clear they will not be willing to settle the issue.

Also, although I provided an initial answer, it’s important that you are 100% satisfied. If you feel I have done so, please rate me 5 stars and let me know if you have any follow up questions. As a side note, you can also click here in the future to request me individually.

Customer: replied 1 month ago.
Correct so the doctor is not verifying my claim however the other two doctors are . So it's the dr word against mine I do not want this to go to court or take forever to end . I have three kids I'm a single mom I can't be in and out of court I have no money to pay for a lawyer and I want this over . My claim is for accidental insurance and my sons claim can be verified as a factual claim by two places just not the sr I worked for . I need to know should I seek counsel . But I have no money to do so the amount of money in question is 6,800 I have read other people cases where some pleaded guilty because they wanted to avoid jail and had to pay back money and a 20,000 fine . This is so crazy
Expert:  Legal Eagle replied 1 month ago.

I understand your concern. Usually, an attorney will be able to work on contingency for matters like this. So, if you get paid a settlement for the claim, they may take 33%. however, it's not necessary to have one.

One of the hardest things to do sometimes is find a lawyer that you can trust. Google searches are a good place to start, but usually the lawyers who pay the most can get bumped up to be on the first page regardless of their quality. One thing I recommend is going through your state’s lawyer referral service (LRS). The LRS in each state typically requires the attorney to have several years of practice, be free of discipline, and have adequate staffing to assist people. Here is the link for the Maryland LRS click here.

Customer: replied 1 month ago.
I have never dealt with an insurance place like aflac I'm not sure do all these cases go to court or to a commissioner I'm not sure
Expert:  Legal Eagle replied 1 month ago.

Good question. Frankly, most of them are handled informally outside of court. However, you could bring a lawsuit in small claims (generally under $5,000) or in superior court (over $5,000). 99% of the time, cases like these are never filed. 99.9% of the time, if you file a lawsuit, you will end up settling the matter.

Customer: replied 1 month ago.
That put me at ease . I just can't understand why be dishonest several employee saw my son their on several occasions and even rhr orthopedic tech had to brace my son so to just say you didn't Irs just wrong and I'm poor he's rich what chance do I have to prove he's wrong
Expert:  Legal Eagle replied 1 month ago.

I can't imagine why they would do this. I'm very sorry. However, I think that you'll be in good shape:-)