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When you pay for insurance, it gives you peace of mind that you will not be dealing with severe debt if you have a medical emergency. Unfortunately, you may be shocked to find that your insurance claim has been denied. If you do not appeal, that can leave you paying out of pocket for extensive medical debt.
However, an insurance denial is not necessarily the end of the story. While this denial indicates the insurance company’s refusal to pay, you have options as an insurance policyholder. Know your rights before you accept a claim denial from your Oregon medical insurance company.
When your insurance company denies your medical insurance claim, you have a right as a policyholder to appeal that decision. That can start with appeals within the insurance company, but if they act in bad faith or refuse to take action, you have other opportunities. Below are the two main ways you can appeal your insurance claim denial.
Your first option is to request an internal appeal from your insurance company. You can pursue a complete and fair review of the health insurance company’s decision, which can lead to that decision being overturned. However, even if the insurance company supports this decision, you are not necessarily out of options.
In some cases, the insurance company may continue to refuse, and they may even be acting in bad faith. In these situations, you may want to turn to an independent third party to review and potentially appeal your claim. You may even have grounds to file a complaint with the Division of Financial Regulation, which governs these cases under Oregon law and can force the insurance company to pay for your claim.
In certain situations, this regulatory system may fine the company if it refuses to comply with its policies. In extreme cases, it may even revoke the company’s license. Keep in mind that these investigations may take months to complete, but a full investigation can help you and other patients protect your rights.
At Paulson Coletti, “liberty and justice for all” is more than just a phrase – it is our mandate. Our team of trial lawyers is driven to pursue justice for the injured, ensuring that the responsible parties are held accountable. With a high success rate both in and out of the courtroom, you can trust our Oregon personal injury lawyers to be the legal advocates you need so your voice can be heard.
As you navigate your insurance claim, you may find yourself in the middle of the appeals process. However, you may be unsure what comes next. Fortunately, the Division of Financial Regulation can help, starting with a call or a visit to their department.
If you believe the insurance company is not complying with its policies, you can file a complaint with the Division of Financial Regulation. This group offers advocacy for patients like you who have medical expenses that are not being covered. Once your complaint is filed, the insurance company will be notified.
Following the filing of your complaint, an advocate on your side will complete an investigation. This advocate will review the policy and the company’s actions regarding your case. This process can take up to 60 days to complete.
Once the division of financial regulation has reviewed the case, it will determine whether you have been unfairly denied. If it determines that the denial was unfair, it may force the company to comply and pay for your case. If the insurance company continues to refuse, it may face financial penalties.
“Most cases settle, but each of our cases is prepared as if it’s going to trial. The insurance companies know it and so do the defense lawyers defending them. That’s why we get such great results for our clients.”
No Fees Unless We Win
Unfortunately, many face unfair denials, delays, and interruptions in their coverage from Oregon insurance companies. Insurance companies are for-profit businesses, but you have rights as a policyholder even if the company prioritizes its profits. If you struggle to recover after an acclaimed denial, you can always contact Paulson Coletti Trial Attorneys PC for help.
Your medical malpractice attorney in Portland can offer guidance if mediation and external review are not enough. If you believe your claim require litigation, you can always reach out for a free consultation with our team to learn more about your opportunities. When you are ready to begin, call or complete our online contact form.
At Paulson Coletti, a local firm based in Oregon, justice is our mission. As experienced trial attorneys, we fight for injury victims across Oregon and Washington, holding negligent parties accountable. With a proven track record in and out of the courtroom, we are dedicated to securing fair compensation for our clients. We take a client-centered approach, focusing on cases we believe in and delivering results that matter. No fees unless we win-because justice should never come with financial risk.
Client Reviews
John and Lisa were extremely helpful with my family as we navigated damages sustained in a tragic car accident. They were very knowledgeable throughout the entire process. Their communication and empathy to our situation was greatly appreciated.
I can’t imagine working our way through the tragedy without them by our side. I would highly recommend Paulson and Coletti!
Working with John was an excellent experience from start to finish. He fought long and hard to secure a fair and just settlement in our case, and his dedication never wavered. John and his staff were consistently considerate, helpful, and communicative throughout the entire process, always taking the time to answer our questions and keep us informed. Given the complicated and sensitive nature of our case, I’m truly grateful we had John in our corner. Thanks to his hard work and expertise, we achieved a better outcome than we could have hoped for.
I had an excellent experience working with Jane and her team on my accident case. From start to finish, their team was professional, responsive, and genuinely cared about getting the best possible outcome for me.
I highly recommend Paulson Coletti Trial Attorneys to anyone who needs legal representation. They made a stressful situation much easier to navigate, and I’m extremely grateful for everything they did for me.
I recently engaged John Coletti to represent me in a challenging legal matter, and I cannot recommend him highly enough. From our initial consultation, it was evident that John possessed an exceptional depth of knowledge, strategic acumen, and unwavering dedication to his clients. He took the time to thoroughly understand the nuances of our case, explaining complex legal concepts in clear, accessible terms while always keeping me informed and involved throughout the process.
John not only delivered outstanding results but also provided compassionate support during what could have been an overwhelming stressful time.
If you’re seeking an attorney who combines professionalism, integrity, and proven success, look no further than John Coletti.
My family is profoundly grateful for his representation.
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This page has been written, edited, and fact-checked by our team of legal writers in accordance with our editorial guidelines. It has been approved by partners Jane Paulson and John Coletti—respected trial attorneys with decades of experience representing personal injury victims.
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