If you are a USAA policyholder who has received a denied medical claim, you may be eligible to join a class action lawsuit against the insurance company.
USAA Auto Insurance Medical Payments Denied in Bad Faith?
In today’s for-profit American healthcare landscape, a denied medical claim is an unfortunate fact of life. Regardless of your premiums, no insurance company will approve every claim. The fewer claims a company covers, the more profit it makes.
However, insurance companies like USAA are legally obligated to cover reasonable medical claims under the policies they provide. They are also legally obligated to provide good faith reviews to policyholders appealing insurance denial decisions. That’s what policyholders pay premiums for.
USAA policyholders see their car insurance medical payments reduced or denied at an unusual rate. Several class action lawsuits allege that this is due to a USAA cost containment scheme that hinges on the company’s use of the AI-driven Auto Injury Solutions software.
The lawsuits claim that USAA uses the AIS software to bypass the standard claim review process. AIS may enable USAA to systematically and arbitrarily deny reasonable claims for auto insurance medical payments following car accidents and other covered scenarios. This leaves policyholders responsible for the costs of the denied medical claim, costs which may run into tens or hundreds of thousands of dollars.
The alleged USAA claims denial scheme increases the company’s profits at the expense of their policyholders. You pay your insurance premiums to ensure that you will be covered if medical expenses arise. An insurance company-denied claim can lead to significant financial hardship. No medical insurance cost containment scheme should ruin a policyholder’s life.
If Your USAA Insurance Claim Was Denied
If insurance denies your claim, you have options.
Your first step should be appealing insurance denial to trigger a review of your case. An insurance company acting in good faith will assign an adjustor to investigate your claim in more depth, including collecting additional information from your treating physician(s).
An insurance company acting in bad faith, as USAA appears to be, will continue to deny payment or reimbursement of your medical costs.
If your medically necessary USAA claim is denied after an appeal, you may be a victim of the alleged USAA claims denial scheme. We believe that the high rate of USAA denial of claims due to their use of Auto Injury Solutions software has harmed policyholders like you.
Depending on your USAA claim status, you may qualify for a class action lawsuit against the insurance company. If you were covered by USAA, had an auto insurance medical payments claim denied as not medically necessary, and appealing insurance denial did not change your denied USAA claim status, USAA may have breached the terms of its contract with you.
Reach out to our office to schedule a consultation and learn whether you are eligible to join the class action lawsuit.
