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New York Insurance Bad Faith Questions & Answers
0 Answers | Asked in Insurance Bad Faith for New York on
Q: I had to pay the dentist upfront even though they were in network. I paid $550 for the services. Bill was submitted to

Insurance. My obligation to pay was $79.40. Dentist refused to refund me. The difference between allowed amount and The amount submitted is not charged do the member due to network dentist agreement. Insurance call them regarding refund to me, they refused and told insurance it’s not their... View More

1 Answer | Asked in Insurance Bad Faith for New York on
Q: if I am the owner of a insurance policy for my mother, do I need to turn it in if she is going to receive medicaid
Tim Akpinar
Tim Akpinar
answered on Dec 5, 2023

This isn't an Insurance Bad Faith matter (the category where it is posted). You could repost and add "Elder Law" and "Health Care Law" as categories for better chances of a response - attorneys there could have the best insight into this. Good luck

2 Answers | Asked in Insurance Bad Faith for New York on
Q: Can a doctor recode and bill insurance after receiving a denial claim?

A patient was seen as a new Medicare wellness visit but had previously had one within the year by another physician unbeknownst to the office. So the claim was denied and the Dr. Wants to recode and resubmit.

T. Augustus Claus
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answered on Sep 28, 2023

In New York, a doctor generally can recode and resubmit a claim to insurance if the original claim was denied. However, the recoding must accurately reflect the services provided, and the practice could be subject to audit. Additionally, Medicare has specific rules and timelines for resubmitting... View More

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3 Answers | Asked in Insurance Bad Faith, Medical Malpractice and Personal Injury for New York on
Q: Is there liability for a insurance company if my condition worsens due to their denial of authorization for more PT?

I was undergoing physical therapy for back/ spine issues with intermittent numbness and improving. Additional authorizations by my insurer were suddenly denied. PT office did not appeal immediately and only did once I received a copy of the letter and informed them. An appeal would take 30 days to... View More

Tim Akpinar
Tim Akpinar
answered on Sep 16, 2023

You raise a very good question - and one that does not go overlooked by attorneys in challenging denials of medical care. Unfortunately, it is also a difficult issue to argue in most settings where a claim is closely processed with valid independent medical exams or peer reviews. If you have an... View More

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1 Answer | Asked in Insurance Bad Faith and Contracts for New York on
Q: Is an insurance company responsible for posting wrong information on Plan Summary document?

I received a dental service which is fully covered by my dental insurance, according to the Plan Summary document which my insurance company posted on the webpage. However, it turned out that the summary document was wrong, and it was not covered according to the full benefit document.

Is... View More

Tim Akpinar
Tim Akpinar
answered on Aug 16, 2023

You could make the argument that they are responsible for the incorrect information. They could respond with an argument that the long version policy applies, or that their post is subject to changes, or other provisions. If the denial is substantial, there are health care attorneys who litigate... View More

1 Answer | Asked in Insurance Bad Faith, Contracts and Family Law for New York on
Q: Regarding life insurance?

My dad had signed up for a term life insurance policy for $7000 until he reaches 90 years old, or when he dies. At the time when the insurance company called him to sign up he spoke very little English, that term was set to fully paid in 2013. But he kept paying the policy every month, he passed... View More

Tim Akpinar
Tim Akpinar
answered on Aug 13, 2023

I'm very sorry for the loss of your dad. One option is to try to arrange a brief consult with an attorney - it would be helpful to know the basis of the carrier's denial of a refund. It could be a matter of weighing the costs of litigating the potential refund against chances for a... View More

1 Answer | Asked in Health Care Law and Insurance Bad Faith for New York on
Q: What type of payment would an attorney need for a NY balance billing case (2021 DOS), ie hourly?

What payment structure does an attorney use for a balance billing case in New York by an in-network provider?

In network provider balance billed me though insurance EOB shows $0 owed as their claim from 2021 was discounted to $0. Provider's billing company refused to resubmit their... View More

Tim Akpinar
Tim Akpinar
answered on Apr 24, 2023

Attorneys who handle medical billing disputes apply various fee arrangements, depending on the type of insurance (no-fault, private, etc.), volume of claims (in terms of whether it's a high-volume institutional client, such as a large medical office or single-transaction individuals),... View More

1 Answer | Asked in Civil Rights and Insurance Bad Faith for New York on
Q: Is this illegal? Please note that I have disabilities.

Hi I just wanted to ask if it's legal or illegal for a health insurance company to deny a hospital claim just because you have secondary insurance. I reside in NY state if that matters

Tim Akpinar
Tim Akpinar
answered on Mar 29, 2023

It's difficult to comment whether there was an insurance law or policy violation without knowing the types of insurance, policy conditions, sequence in which hospital billed or otherwise coordinated the claims process between the two carriers. There are health care attorneys who handle billing... View More

1 Answer | Asked in Health Care Law and Insurance Bad Faith for New York on
Q: I was denied an MRI from Emblem health several times. New insurance now diagnosed with arthritis can I sue Emblem?

Emblem was my former insurance through my former employer. I suffer from hip pain. I was approved for an X-ray of my hip which showed normal. However the pain was severe. My PCP requested an MRI on my behalf several times, but Emblem denied the request each time. My coverage ended with Emblem on... View More

Tim Akpinar
Tim Akpinar
answered on Oct 5, 2022

I'm sorry for your ordeal. You ask if you could sue. I think it would be difficult to find a law firm to handle such a matter on a contingency basis. MRIs are often initially denied as a knee-jerk reaction in many instances. They are big-ticket items compared to other less-sophisticated... View More

1 Answer | Asked in Insurance Bad Faith for New York on
Q: Can my old insurance charge me for medications they paid for after I lost coverage?

I am on a monthly medication paid for by my insurance, I switched jobs and thus got new insurance, but the pharmacy kept billing the old insurance.

The old insurance continued paying for my medications for 5 months. Now they're charging me a hefty ammount for the months they paid for... View More

Tim Akpinar
Tim Akpinar
answered on Apr 19, 2022

I'm sorry you find yourself at the end of a collection action with the medications. It's difficult to comment definitively on your position without seeing the terms of the policy and other paperwork. However, it sounds like they may be relying on the position that the patient has a... View More

1 Answer | Asked in Insurance Bad Faith and Insurance Defense for New York on
Q: Can i sue an insurance company

So my dilemma is I have a car accident reported on my car accident history last year. I have never been in an accident in my life. My mom got in an accident last may and i was in the car. She called me a week later and told me her insurance wanted to speak with me i explained the situation to them... View More

Tim Akpinar
Tim Akpinar
answered on Mar 12, 2022

Some elements of the scenario are not fully clear, but from the brief facts, it does not look like a case of insurance fraud. Insurance fraud cases generally involve deliberate conduct with the intent to deceive the other party. This looks more like it could be an administrative or communications... View More

1 Answer | Asked in Health Care Law, Insurance Bad Faith, Insurance Defense and Civil Rights for New York on
Q: Can a health care provider accept insurance based on merit of the patient?

A dentist office accepts my current insurance. But make me pay full price, bills my insurance separately then sends me a check for less than 50% of what I payed when my insurance covers 80% of the total visit. They also only make some people who have the same insurance pay. So if you and I both had... View More

Tim Akpinar
Tim Akpinar
answered on Feb 11, 2022

It could be difficult to speculate why a dental or medical office would apply different billing protocols. As a convenience to the patient, some offices do not bill patients but instead, have them complete paperwork enabling their billing staff or contractor to bill on patient's behalf. When... View More

1 Answer | Asked in Insurance Bad Faith and Insurance Defense for New York on
Q: Insurance company denied medically necessary breast reduction. My back is now more damaged. Can I sue?

Hi,

I have a very large chest and as such I also suffer from crippling back pain. It has gotten to the point I can no longer function normally and cannot even get out of bed some days due to sciatica. I tried to get my insurance company to pay for a breast reduction and they denied me. In... View More

Tim Akpinar
Tim Akpinar
answered on Dec 16, 2021

I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law... View More

2 Answers | Asked in Insurance Bad Faith, Personal Injury and Products Liability for New York on
Q: Why would a claims adjuster deny a claim and then turn around and want to offer payment for pain caused by the incident?

I am the third party in a product liability insurance claim. The claim was denied earlier this month and just yesterday, the adjuster called me wanting to "resolve" the claim by offering payment for "pain" from the injury.

Before the insured sent the complaint over to... View More

Jonathan R. Ratchik
Jonathan R. Ratchik
answered on Oct 4, 2021

When you state you're the "third party" I'm assuming you mean you're the claimant and not a third-party defendant. Regardless, as my colleague correctly advised, the claims adjuster's change in position can be due to many reasons. More likely than not, the adjuster... View More

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2 Answers | Asked in Personal Injury and Insurance Bad Faith for New York on
Q: How somebody can claim personal injuries in front of my house if there is no obstacles, potholes or cracked sidewalk?

If somebody claims that got hurt in front of my house how can request to be paid by my house liability insurance? My security system is old and cannot record, just view. Out of nowhere you just try to get money from your neighbors ?

Tim Akpinar
Tim Akpinar
answered on Sep 25, 2021

Your homeowner insurance company will thoroughly investigate the matter. It is not enough for someone to simply fall. They must show that it resulted from a defect in the surface or negligence on your part. The claims adjustor or defense attorney from your insurance company should be able to... View More

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1 Answer | Asked in Insurance Bad Faith for New York on
Q: Is it illegal for grandmother to keep insurance cards if I’m 19?

So I live with my grandmother. I’m 19 years old and moving out in august. She loves having control of everything! The thing is she has my insurance cards and refuses to give them to me. I’m going to need them when I move out. My college requires me to have my own insurance and I would like to... View More

Tim Akpinar
Tim Akpinar
answered on Jul 7, 2021

One option might be to contact the insurance carrier to request duplicate cards. Good luck

Tim Akpinar

1 Answer | Asked in Consumer Law and Insurance Bad Faith for New York on
Q: 1. How to find life insurance company's divisible surplus for last 15 to 30 years? 2.by insurance class? $0 div?

year 1968 participating $5,000 whole life policy. no dividends for last 15 years. Prior to that, div increased each year (to $96) then decreased in the next 4 yrs to zero; for 12 yrs $0 , however cash value increased each yr ($3,900 currently and increases a small amount each yr), no loans ,... View More

Jonathan David Warner
Jonathan David Warner
answered on May 31, 2021

I'd recommend looking into New York's State's Unclaimed Funds registry, which can be found by clicking on this link:

https://www.osc.state.ny.us/unclaimed-funds

If you're entitled to funds that are unclaimed, they might be held by the State in escrow.

Good luck with your case!

1 Answer | Asked in Banking, Insurance Bad Faith and Insurance Defense for New York on
Q: what to do if my bank refuses my father's life insurance claim?

My father's bank refuses to pay me by telling me that my father did not contributed the last months before his death without giving me any official paper or proof. My father contributed to this insurance for more than 30 years and it's a shame not to get any penny..

Tim Akpinar
Tim Akpinar
answered on May 9, 2021

I'm sorry for your ordeal that makes a difficult situation even more painful. It appears you've already requested records. It's difficult to offer step-by-step instructions here, as the next step could possibly require litigating the claim, depending on the situation. Reach out to... View More

1 Answer | Asked in Insurance Bad Faith for New York on
Q: Hedgepeth v Home Savings and Loan Assoc 361 S.E 2d 888 ( NC App. 1987) Please briefly describe what occurred in the cas
Tim Akpinar
Tim Akpinar
answered on Nov 12, 2020

There is a resource on the case here on the Justia site. Enter the following page link in your browser:

https://law.justia.com/cases/north-carolina/court-of-appeals/1987/8715sc224-1.html

Good luck

Tim Akpinar

1 Answer | Asked in Insurance Bad Faith for New York on
Q: An insurance company we were with for 11 years quadrupled our homeowners premiums during this time Is this legal?

We Filed a couple of homeowners claims several years back and they kept exorbitantly upping our premiums year after year Annually I would call them and ask what could be done to better our rates. They offered nothing. our Renewal policies came in through the roof For oct 2020 so we decided to... View More

Tim Akpinar
Tim Akpinar
answered on Sep 29, 2020

Multiple claims could cause a significant rise in premiums. In terms of the other matter, you may need to review the file with an attorney in terms of the basis for the retroactive assessment - whether stemming from representations upon which their underwriters assessed the risk. Based on the... View More

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