September 28, 2024

What Does Bad Faith Claim Mean in the Legal Space?

In the legal World, a bad faith claim arises when an insurance company acts dishonestly or unfairly toward its policyholder, failing to fulfill its contractual obligations. As described in the Munley Law Glossary, bad faith claims play a crucial role in insurance disputes, often involving situations where an insurer unjustly denies a claim, delays payment, or undervalues compensation owed to the policyholder. Understanding bad faith claims is essential for consumers who rely on insurance companies to act in good faith and uphold their end of the agreement.

Defining a Bad Faith Claim

At its core, a bad faith claim refers to a legal cause of action that allows policyholders to seek compensation from an insurance company that has wrongfully denied or mishandled a legitimate insurance claim. Insurance policies are contracts, and under these contracts, insurers are obligated to act in “good faith” and deal fairly with their policyholders. When they fail to do so, it is considered acting in bad faith.

Examples of bad faith behavior by an insurance company may include:

Unjustly denying a valid claim: This happens when the insurer refuses to pay for a covered loss without a reasonable basis.
Delaying the claim process: Some insurers may unnecessarily delay the investigation or payment of a claim, causing Financial hardship for the policyholder.
Offering an unfairly low settlement: The insurance company may try to settle a claim for significantly less than its actual value.
Failure to properly investigate the claim: Insurers are required to thoroughly investigate a claim to determine its validity. If they ignore key facts or fail to conduct a reasonable investigation, it can be grounds for a bad faith claim.

Types of Bad Faith

There are two main types of bad faith claims in the insurance context: first-party bad faith and third-party bad faith.

First-Party Bad Faith:
- First-party bad faith occurs when the insurer fails to handle a claim made directly by the policyholder. For example, if someone files a homeowner’s insurance claim after a fire damages their property, and the insurer wrongfully denies coverage, the policyholder may bring a first-party bad faith claim.
Third-Party Bad Faith:
- Third-party bad faith typically involves liability insurance claims, where the insurer has a duty to defend and indemnify the policyholder in lawsuits brought by others. For example, if an insurer fails to settle a lawsuit within policy limits, leaving the policyholder exposed to excess liability, the policyholder may have grounds to bring a third-party bad faith claim.

Common Examples of Bad Faith Actions

Insurance companies engage in bad faith practices in various ways, including:

Refusal to communicate: If an insurance company consistently fails to respond to inquiries or delays communication, it may be acting in bad faith.
Failure to investigate: An insurance company is required to thoroughly and promptly investigate a claim. If it fails to do so, the policyholder could have a case for bad faith.
Unreasonable interpretation of policy language: Sometimes, insurers use overly narrow or unreasonable interpretations of policy terms to deny a claim. This is considered a bad faith practice.
Offering a lowball settlement: When an insurer knowingly offers much less than the policyholder is entitled to, it can be considered bad faith.
Ignoring or misrepresenting facts: Misrepresentation of the facts or ignoring key evidence is another common bad faith tactic used to deny or devalue claims.

Legal Consequences of Bad Faith

When a policyholder believes they have been wronged by their insurance company, they can file a bad faith claim. If successful, the insurance company may be liable for various damages, including:

The original claim amount: The insurer may be required to pay the full amount of the claim that was originally denied or underpaid.
Consequential damages: This could include financial losses that resulted from the insurer’s bad faith, such as costs incurred due to delays in receiving payment.
Emotional distress: In some cases, if the bad faith action caused significant emotional suffering, the policyholder may be compensated for pain and suffering.
Punitive damages: Courts may award punitive damages in egregious cases of bad faith to punish the insurer for particularly harmful or deceptive conduct and to deter similar actions in the future.
Attorney’s fees: The policyholder may also recover attorney’s fees and legal costs associated with bringing the bad faith claim.

Proving a Bad Faith Claim

In order to prevail in a bad faith lawsuit, the policyholder must demonstrate that the insurance company acted unreasonably and without a legitimate basis in handling their claim. This typically requires showing that:

The claim was valid: The policyholder must prove that their insurance claim was legitimate and covered under their policy.
The insurer failed to honor its obligations: Evidence must be provided that the insurer did not act in good faith and failed to meet its contractual duties.

How to Protect Yourself Against Bad Faith

There are a few steps policyholders can take to reduce the chances of facing bad faith actions from their insurer:

Keep detailed records: Always document your communications with the insurance company, including emails, letters, and phone conversations. Having a paper trail can be crucial if a bad faith claim arises.
Know your policy: Make sure you understand the terms and conditions of your insurance policy. This knowledge can help you spot unreasonable denials or delays.
Act promptly: File your claim as soon as possible and respond promptly to any requests from the insurer.

June 19, 2024

What Is Medicare Part B: Your Guide

Imagine standing at a crossroads, one path veering towards uncharted territories of health care and the other into the familiar embrace of traditional medical insurance. At this junction, what is Medicare Part B? Delving into Medicare Part B feels like embarking on a journey where the paths of medical assistance and outpatient care blend seamlessly under the canopy of governmental backing.

The world whispers tales of coverage that extends beyond hospital stays, whispering secrets about preventive services designed to shield us from illness’s shadow before it even falls. With every step we take in understanding Medicare Part B, we tread on ground fertile with options for durable medical equipment and necessary lab tests – essentials that stitch together the fabric of our well-being.

Yet here lies the conundrum: how does one decipher which paths are paved with gold-standard premiums and which lead astray? Let me guide you through these misty forests filled with monthly premiums and enrollment periods whispered by winds older than time. And yes, amidst this tangled web of choices lie opportunities gilded in knowledge—knowing when to leap can make all the difference. Together, we’ll traverse this labyrinth, revealing the keys to safeguard your twilight years from lurking hazards.

Understanding the Basics of Medicare

Let’s break it down, shall we? Navigating through Medicare can feel like you’re trying to learn a new language. But don’t worry; we’ve got your back.

Breaking Down Medicare Parts A, B, C, & D

Medicare Part A covers hospital stays and nursing care. Part B covers your doctor visits and preventive services. Medicare Advantage (Part C) combines Parts A and B into one plan with some extra benefits. Part D covers prescription drugs.

How Does Medicare Work?

Original Medicare covers health care basics under Parts A and B, from inpatient hospital stays to doctors’ outpatient services. Then you’ve got options like the Advantage Plan for added perks or Part D for prescription medications.

Diving into Medicare feels like learning a new language, but we’re here to help. From hospital stays with Part A to prescriptions with Part D, get the scoop on your coverage options. #MedicareExplainedClick to Tweet

Deep Dive into Medicare Part B

Diving right in, let’s get to the Heart of Medicare Part B. Medicare Part B isn’t merely a component of the healthcare mosaic; it represents your passport to accessing vital medical treatments that ensure you continue to function optimally.

Eligibility for Part B: Who Can Apply?

First off, if you’re 65 or older, congratulations. You’re in. But there’s more – folks under 65 with certain disabilities or anyone with End-Stage Renal disease (ESRD) can also join the club. Check out how this works.

Enrollment Periods and Coverage Start Dates

You’ve got windows of opportunity here – mainly when you first become eligible and each year after during open enrollment. Missed your slot? Don’t sweat; special periods might have your back. Craving the full scoop on everything? The Social Security office has them ready for you.

Is IRMAA Calculated Every Year? A Comprehensive

Have you ever been surprised by a hike in your medicare premiums? Felt like you were on an unexpected roller coaster ride with the is IRMAA calculated every year question hanging over your head? You’re not alone. Many folks find themselves perplexed by this annual riddle.

The Income-Related Monthly Adjustment Amount, or IRMAA, might seem as unpredictable as a wild horse at first glance. But there’s actually a method to its madness and understanding it can help tame that stallion.

This post is your trusty guide through the prairie of premium adjustments. We’ll navigate together across tricky terrain – from income brackets and tax returns affecting IRMAA calculations, to how Social Security gets involved, and even into appeal territory if things go south.

Keep reading for valuable insights on how to navigate the yearly recalculations and their nuances.

Understanding IRMAA Calculation

You might be asking, “Is IRMAA calculated every year?” The answer is yes. Each year, the Social Security Administration (SSA) uses a sliding scale based on your Modified Adjusted Gross Income (MAGI) to calculate any possible IRMAA surcharge.

The SSA takes into account different income brackets or ‘IRMAA Brackets’ as they’re often called. This establishes how much of your Medicare Part B and D premiums you must pay out, based on the MAGI income range. Higher income means more premiums paid.

This may seem daunting at first glance but don’t fret. It’s simply an extra fee for higher-income beneficiaries that help keep Medicare solvent.

Income Thresholds and IRMAA Calculation

Moving up in the world has its perks but it can also bump you into a new income threshold. That could lead to paying more for your Medicare coverage because of an increased IRMAA surcharge. But remember – everyone loves progress.

In fact, think of this like moving up from economy class on a flight where now there are just additional costs associated with those luxurious legroom seats upfront. You get better service perhaps even champagne- here in our case it helps fund medical care services nationwide.

Your Appeal Rights: Don’t Fear The Letter

If by chance you disagree with the initial determination about whether or not you should pay IRMAAA, fear not my friend; Uncle Sam lets us appeal these decisions too. And let me tell you, this isn’t a game of monopoly where we dread getting that letter in the mail.

Indeed, dealing with IRMAA appeals can feel like life has handed us lemons, especially when we experience a drop in income due to significant life Events such as retirement or loss of pension. You can file an appeal with the SSA, which has made it more straightforward by providing a Life form. They have made this process simpler by providing a Life form for our use.

May 28, 2024

Beware of Criminal Scammers Pretending to be from Canopy

No one wants to be a victim of fraud. Unfortunately, criminal scammers are continuously evolving their tactics and technology to find new ways to commit fraud. Recently, we’ve been getting reports from our members at Canopy Credit Union that scammers have been targeting some of them by spoofing Canopy’s main phone number and pretending to be representatives of Canopy. These scammers are taking advantage of the trust our members have when they see our phone number flash on their caller IDs, with no way to tell that it’s a fake number. The scammers are using information they’ve gleaned about the members they are contacting, which can include names, addresses and other details, in order to convince the members to give them additional sensitive data, such as login information, account numbers, social security numbers, or card numbers.

Your Security is Our Top Priority

Canopy takes all security risks seriously and treats all threats with the highest priority. We want our members to know that we will never ask for personal details over the phone or through e-mail communications. If someone reaches out to you and requests information that feels suspicious, such as your account password, social security number, credit or debit card details, or accounts numbers, hang up immediately. Reach out to us afterwards with a phone call to 509.328.2900 or through the secure online chat at canopycu.com. Actual representatives from Canopy will never ask you for this kind of information over the phone.

HOW TO TELL IF IT’S REALLY US

When a representative from Canopy is legitimately reaches out to a member because of a suspicious transaction alert, we provide you with the exact merchant the transaction was charged from, the date the purchase took Place, and amount of the transaction in question. If it turns out that the transaction is the result of fraud, we will ask if the address we have on file for you is the correct one to send a new card out to, and we will state the address in full, checking with you only if it needs to be updated.

As always, if a member does not feel comfortable communicating over the phone, we applaud them for being cautious. With so many scammers learning more and more about everyone through data breaches on the dark web, it is always better to be safe than sorry. If for any reason you feel unsure about a phone call that appears to be from Canopy, hang up and call us back or come into a branch to speak with a member of our team in person.

FRAUDSTERS USE YOUR INFORMATION TO SOUND LEGITIMATE

To make themselves sound more legitimate, fraudsters are giving fake case numbers, names, and asking members to call them back on a different line than Canopy’s. If you receive a voicemail message asking you to call back on a number that is not Canopy’s main phone line of 509.328.2900, treat it with suspicion and call us directly instead.

To minimize the chances of becoming a target for fraudsters, it’s important that you are diligent about where and how often you share sensitive information on the web. Fraudsters work full time obtaining as much information about their targets as they can before reaching out to them. They look for addresses, family tree information, search through social media, and gather data from the dark web released in data breaches. When they have a list of targets, they research which Financial institutions their targets may belong to and reach out to them, pretending to be from one of their trusted banks or credit unions.

What You Can Do to Protect Yourself

One of the best things members can do to protect their sensitive data is sign up for a service that scans for their information on the dark web and will alert them to take action when it’s found. At Canopy we offer this service through Norton LifeLock for free when our members obtain one of our credit cards, but even then, members need to be wary of scammers impersonating Norton as well.

Canopy is always striving to provide the highest level of security possible for our members. Even so, it’s vital that our members remain vigilant and alert regarding any suspicious callers or e-mailers requesting any specific information about accounts or personal identity. If you have any questions or concerns regarding the security of any of your accounts or information at Canopy, please feel free to reach out to us by phone, chat, or by stopping into to any of our branches.

Canopy Credit Union | Protect Yourself

February 18, 2024

Electronic Recycling Atlanta: Redefining Recycle Atlanta with Advanced Recycling Centers

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November 6, 2023

Building Your Dreams: Understanding House Building Loans

The dream of building your own home, one that perfectly suits your needs and desires, is an aspiration many hold dear. A house building loan, also known as a construction loan, is the financial key that unlocks this dream, turning architectural plans into bricks and mortar. In this article, we will delve into the world of house building loans, explaining what they are, how they work, and why they are essential for building your dream home.

What is a House Building Loan?

A house building loan is a specialized financial product designed to provide the necessary funds to construct a new home from the ground up. Unlike traditional mortgages that are used to purchase existing homes, construction loans cater specifically to those undertaking the construction of a new dwelling. These loans serve as the financial backbone of your construction project, offering a unique set of features tailored to the challenges and costs associated with building a home.

How House Building Loans Work:

1. Construction Phase: One of the primary distinctions of house building loans is how they handle disbursements. During the construction phase, borrowers receive funds from the lender in stages, as the construction project progresses. This disbursement structure ensures that the money is used for its intended purpose and reduces the financial burden on the borrower. Importantly, during the construction phase, borrowers often make interest-only payments, making the process more manageable.

2. Conversion to Permanent Mortgage: Once the construction of the home is complete, the house building loan typically converts into a permanent mortgage. This transition is often seamless and does not require a separate loan application or approval process. The terms of the permanent mortgage, such as interest rates and monthly payments, are determined by the borrower’s creditworthiness and the lender’s offerings.

3. Qualification Requirements: Qualifying for a house building loan can be more intricate than securing a traditional mortgage. Lenders typically require detailed project plans, cost estimates, and a strong credit history. Additionally, they assess the borrower’s ability to effectively manage the construction project. This involves evaluating the borrower’s experience and the credentials of contractors and professionals involved in the construction.

The Benefits of House Building Loans:

1. Customization:** House building loans empower you to create a home tailored to your preferences and needs. You have control over the Design, layout, and features, ensuring that your dream home becomes a reality.

2. Cost Efficiency: Construction loans can be more cost-effective than purchasing an existing home, especially if you have a clear vision and are willing to manage some aspects of the project.

3. Interest Savings: The interest-only payments during the construction phase can save you money in the short term, as you are only paying interest on the disbursed funds.

4. Seamless Transition: The transition from a construction loan to a permanent mortgage is often straightforward. This eliminates the need for a separate application process, which is common with traditional mortgages.

Selecting the Right House Building Loan:

When considering a house building loan, it’s essential to shop around and compare offers from various lenders. Here are some factors to keep in mind:

1. Interest Rates: Compare interest rates from different lenders. While construction loan interest rates may be variable during the construction phase, some lenders offer the option to lock in a fixed rate once the loan converts to a permanent mortgage.

2. Fees and Costs: Be aware of any fees associated with the loan, such as origination fees, application fees, and closing costs. These can significantly impact the overall cost of your project.

3. Lender’s Experience: Choose a lender with experience in construction lending. They will be more familiar with the unique challenges and intricacies of construction loans.

4. Loan Terms: Consider the loan terms, including the length of the construction phase and the transition to a permanent mortgage. Make sure they align with your project timeline.

5. Flexibility: Look for a lender that offers flexibility in terms of disbursements and customization. This can make managing your construction project more manageable.

In Conclusion: construction loan lenders

A house building loan is your ticket to transforming architectural dreams into a tangible reality. These specialized loans provide the necessary financial support, flexibility, and control to bring your unique vision of a home to life. When embarking on a house building project, careful planning, selecting the right lender, and understanding the intricacies of construction loans are key to ensuring a successful and fulfilling home-building journey.

September 2, 2023

Medical Evidence for Disability: What Do You Need to Know

The goal of an SSA analyst is to determine if you fall under their definition of disability so that you can claim long-term disability benefits. As a claimant, you’re responsible for providing medical evidence of your impairments and their severity. While SSA can gather the evidence based on your list of resources, having proof ready makes processing your benefits faster.

Submitting Medical Evidence Scenarios

The SSA analyst will need medical evidence such as copies of your medical records, health worker reports, and recent test results. However, there are some misconceptions people may have that they unintentionally delay filing their claims. Here are some scenarios we hope to clear up:

Scenario 1: You have your copies of medical evidence

Submit them immediately. When you have it ready, it makes filing your claims faster.

Scenario 2: You have incomplete copies of medical evidence

Submit the ones you have immediately. Applying early may help you retain your disability benefits. SSA will do the rest by contacting your medical source(s) to send your other evidence to them. Or you can gather the rest to make the process faster.

Scenario 3: The obtained evidence from you and your medical source(s) is insufficient

The SSA analyst will ask you to undergo a Consultative Examination (CE) paid from their pocket. However, SSA may prefer an independent medical source to your hospital or clinic to conduct the CE.

The Three Keys for a Strong Medical Evidence

Ideally, CE is a convenient way for claimants to get a complete and detailed medical record sufficient for SSA. But to save time and energy, you can build robust medical evidence to make your process faster without requiring CE or making several trips to the SSA.

Admissible evidence must have the following:

Severity of impairment(s),
Duration of the impairment(s), and
Limited functions that the impairments cause (walking, lifting, going to the bathroom, etc.)

We can use SSA CE’s objective and subjective evidence requirements to show the severity and duration of impairment(s) and how it limits the claimant.

How to Strengthen a Disability Case with Objective Evidence

Objective evidence is measurable or clear signs of abnormalities that cannot be faked or exaggerated:

Get all recommended diagnostic and laboratory testing.
Have additional testing to provide more accurate proof of your symptoms and limitations.
Create a detailed list of your medical appointments.

How to Strengthen a Disability Case with Subjective Evidence

Subjective evidence is documented symptoms experienced by the claimant. The more consistent the subjective evidence is, the stronger it is as evidence:

Reporting all your symptoms to your doctors at every appointment for proper documentation
Following your doctors’ prescriptions and recommended treatments (non-compliance can be seen as disinterest in getting better)
Keep a detailed record of your medications and their side effects to give SSA an understanding of how your meds can impact your daily living

How to Strengthen a Disability Case with Medical Expert Opinion

Your healthcare provider’s assessment of your condition can provide insightful information on how it impacts your life. A signed evaluation or narrative letter of your chief complaint(s) can strengthen your case.

Getting treated frequently helps your doctor be familiar with your conditions and their consistency within your medical record.

How Marken Law Can Help You

Consistency among the objective and subjective evidence and medical consultation strengthens your disability case. At Marken Law, we review your disability case for inconsistencies and missing requirements. Then, we add more supportive medical opinions to create your extensive medical evidence.

Depending on the case, here are our methods to make explicit disability claims for you:

Interview your doctor through a questionnaire. The questionnaire we provide is relevant to your specific conditions. The results are drafted so the SSA analyst understands how your condition limits your daily activities.
Collect clarifying answers for you. We contact your healthcare providers on conflicting data, unexplained findings, and complicated conditions so the SSA analyst does not have to.
Get medical opinions from our medical network. As lawyers licensed in Washington, Idaho, Oregon, and California, our medical connections objectively review your medical evidence, and we record their evaluations. Their evaluations can support the expert opinions of your healthcare providers.

Glaring medical evidence cannot be ignored. To get approval for your disability claims fast, you’ll need to get everything right.

To learn more about this, please check out Marken Law