Court rulings on insurance claims filed after policy administrative guidelines.

[dgsiler]

What is the name of your state? Utah (The insurance carrier is in Pennsylvania, as is the employer)

Our health insurance carrier has denied reimbursement for prescriptions only because the claim was filed after the time guidelines in the policy.

Several years ago, I read that courts have required insurance companies must pay the claims according to the terms of the policy if the only reason was a late filing for benefit payments. The courts stated that in order to deny the payment, the insurance company would have to prove that paying the claim late would cause the insurance company financial harm, and also stated that by delaying the required payments, the insurance company had actually enjoyed a financial benefit.

Can anyone point me in the right direction to find such court rulings information?

Thank you very much!

Don