Do I have any rights against an insurance company that delayed a dental claim which resulted in my losing a tooth?
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Do I have any rights against an insurance company that delayed a dental claim which resulted in my losing a tooth?
About 8 months ago my dental office sent in the required pre-authorization for a crown for my tooth that had diagnosis of “cracked tooth syndrome”. They denied it. We appealed and after another month they said they never received it. We sent it again, along with many phone calls from myself and my dental office. Trying to get answers. Never heard back again after sending all my paperwork and diagnostic X-rays to this address, this fax number, we were told something different every time. My tooth split more and I have been in horrible pain for a week over the Thanksgiving holiday. My dentist got me right in this morning and now it was too late to save. The fracture split wide open; the tooth had to be extracted. Any retaliation rights?
Asked on December 1, 2014 under Personal Injury, Washington
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 9 years ago | Contributor
No, you do not have any claim against the insurer. They did not prevent you from having the work done: ou could have paid for it yourself, then sought reimbursement from the insurer if you felt that they had improperly denied or delayed your claim in violation of their obligations under your policy (which is a contract). Since you could have made other payment arrangments and had the work done, the insurer is not causally resonsible for the damage to your tooth; without a causal link, they would not be liable.
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