When Your Insurance Company Refuses to Pay, the Bills Do Not Stop

A denied medical insurance claim does not just create a financial problem. It creates a crisis. The surgery your doctor recommended, the treatment plan you were counting on, the medication that keeps a chronic condition manageable, all of it stalls the moment an insurer decides the claim does not meet its internal criteria.

You paid your premiums. You followed the rules. And now the company that collected your money every month is telling you that the coverage you expected is not available when you need it most. That feeling of betrayal is not irrational. It is the natural response to a system that was supposed to protect you.

Frankl Kominsky medical insurance coverage lawyers in Florida represents policyholders who have been wrongfully denied medical insurance coverage, underpaid on valid claims, or subjected to unreasonable delays by their insurers.

Our team handles these disputes aggressively because we understand what is at stake: your health, your finances, and your ability to move forward.

Call our Boynton Beach office at (561) 800-8000 for a free consultation, available 24/7 in English, Spanish, and Creole.

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Why Choose Frankl Kominsky Injury Lawyers to Fight Medical Insurance Disputes Across South Florida

Insurance companies employ teams of adjusters, in-house attorneys, and medical reviewers whose job is to find reasons to deny or reduce claims. Policyholders facing that kind of institutional resistance need more than a strongly worded letter. They need attorneys who understand how Florida's insurance laws hold carriers accountable.

Results Built on Aggressive Claim Handling

We do not send form letters and wait. Our attorneys review the denial, identify the specific policy provisions at issue, and build a case designed to force the insurer to honor its obligations.

When an insurer refuses to act in good faith, we file a Civil Remedy Notice with the Florida Department of Financial Services and pursue a bad faith claim under Florida Statute § 624.155. We have filed these notices on behalf of policyholders across South Florida whose insurers refused to pay valid medical claims.

Local Knowledge Across South Florida

With offices in Boynton Beach, Pompano Beach, Port St. Lucie, and Palm Bay, our attorneys handle insurance disputes throughout Palm Beach County, Broward County, and the Treasure Coast. We know the local courts, the regional insurers, and the patterns of claim denial that affect South Florida policyholders specifically.

Personalized Support from the First Call

Every case begins with a detailed review of the denial letter, the policy language, and the medical documentation supporting the claim. We assign an attorney and a support team who stay with the case from intake through resolution.

Our clients speak with the people working on their files, not a general call center.

Obstacles Policyholders Face and How We Overcome Them

Insurance coverage disputes are not accidental misunderstandings. They are the product of a system designed to protect the insurer's bottom line. Our attorneys see these patterns repeatedly in cases across South Florida, and we know how to dismantle each one.

Denied claims based on medical necessity determinations: Insurers frequently deny coverage by claiming that a treatment is not medically necessary, even when the policyholder's treating physician says otherwise. We gather supporting medical evidence, obtain peer review opinions, and challenge the insurer's internal review process.
Unreasonable delays in claim processing: Some insurers drag out the review process for months, hoping the policyholder gives up or pays out of pocket. Florida law requires insurers to handle claims promptly and in good faith. When they do not, we hold them accountable.
Lowball settlement offers on valid claims: An insurer that acknowledges partial coverage but offers far less than the claim is worth is still acting against its obligations. We calculate the full value of the claim and reject offers that fall short.
Policy rescission and retroactive denials: In some cases, insurers attempt to cancel a policy retroactively or claim that the policyholder made material misrepresentations on the application. We review the original application and the insurer's underwriting history to challenge these tactics.
Refusal to cover ongoing treatment: A claim denial that interrupts an active treatment plan may worsen the policyholder's medical condition. We move quickly to challenge these denials and seek emergency relief where appropriate.

Each of these obstacles requires a different legal strategy. Our attorneys identify the right approach based on the denial, the policy, and the insurer's conduct.

Who Qualifies for Legal Help with a Medical Insurance Dispute in Florida

If you hold a medical insurance policy in Florida and your insurer has denied, delayed, or underpaid a claim, you may have grounds for legal action. Eligibility depends on several factors, but the following situations commonly support a claim.

Wrongful denial of a covered treatment or procedure: The insurer refused to authorize or pay for a treatment that falls within the policy's coverage terms.
Failure to process a claim within a reasonable timeframe: The insurer has delayed action on a submitted claim without a legitimate justification.
Bad faith claim handling: The insurer's conduct goes beyond a simple coverage dispute and rises to the level of bad faith under § 624.155, including refusing to settle when the obligation to do so has become reasonably clear.
Denial after an accident or injury: If you were injured in an accident and your medical insurer or PIP carrier refused to cover treatment costs, you may have both an insurance dispute claim and a personal injury claim.
Retroactive policy cancellation: The insurer attempted to rescind your policy after you filed a claim.

Our attorneys evaluate each case during a free consultation to determine whether the facts support a coverage dispute claim, a bad faith claim, or both.

Types of Medical Insurance Coverage Cases We Handle

Medical insurance disputes take many forms. The type of policy, the nature of the denial, and the insurer's conduct all affect the legal strategy. Our team has handled disputes involving every major category below.

Health Insurance Claim Denials

When a health insurer denies a claim for hospitalization, surgery, diagnostic testing, prescription medication, or rehabilitation, we review the denial against the policy language and Florida law to determine whether the insurer breached its obligations.

PIP (Personal Injury Protection) Disputes

Florida's no-fault insurance system requires drivers to carry PIP coverage. When a PIP carrier denies or underpays medical treatment after an accident, we pursue the claim through the insurance dispute process and, where applicable, through bad faith litigation.

Managed Care and HMO Denials

HMOs and managed care organizations sometimes deny referrals to out-of-network providers, refuse to authorize procedures recommended by the treating physician, or impose arbitrary limits on covered treatments. We challenge these denials using the policy terms and applicable Florida statutes.

Employer-Sponsored Group Plan Disputes

Disputes involving employer-sponsored group health plans may involve both state and federal law, including ERISA. Our attorneys identify which legal framework applies and pursue the claim through the appropriate channel.

Medicare and Medicaid Supplement Coverage Disputes

When a supplemental insurance policy fails to pay claims that Medicare or Medicaid does not fully cover, the policyholder may face unexpected out-of-pocket expenses. We review the supplement policy and the coordination of benefits to identify the insurer's obligation.

Bad Faith Insurance Claims

When an insurer's conduct goes beyond a simple coverage dispute, a bad faith claim under § 624.155 may allow recovery beyond the original policy limits. Bad faith claims require a Civil Remedy Notice filed with the Department of Financial Services at least 60 days before filing suit. We handle every step of this process.

What You May Recover in a Medical Insurance Coverage Dispute

The compensation available in a medical insurance dispute depends on the nature of the claim and the insurer's conduct. Our attorneys pursue every category of damages that the facts support.

Coverage of the Original Claim

The primary goal is to compel the insurer to pay the claim it wrongfully denied or underpaid. This includes medical bills, treatment costs, prescription expenses, and any other covered services that the insurer refused to honor.

Consequential Damages

If the insurer's bad faith caused additional harm, such as worsening of a medical condition due to delayed treatment, additional out-of-pocket costs, or financial hardship, those consequential damages may be recoverable. Under § 624.155, damages include those that are a "reasonably foreseeable result" of the insurer's violation.

Punitive Damages

In cases involving egregious insurer conduct, Florida law allows for punitive damages. These are intended to punish the insurer and deter similar behavior. Punitive damages require showing that the insurer's bad faith conduct occurred with sufficient frequency or severity to warrant additional penalties.

Attorney's Fees and Costs

In successful bad faith claims, the insurer may be ordered to pay the policyholder's attorney's fees and litigation costs. This provision exists specifically to level the playing field between individual policyholders and large insurance corporations.

FAQ for Medical Insurance Coverage Lawyers in Florida

What is a Civil Remedy Notice and why is it required before filing a bad faith lawsuit?

A Civil Remedy Notice (CRN) is a formal document filed with the Florida Department of Financial Services and served on the insurer at least 60 days before a bad faith lawsuit may proceed. The CRN identifies the specific statutory violation, the facts of the case, and the policy provisions at issue.

It gives the insurer a 60-day window to cure the violation. If the insurer fails to remedy the situation within that period, the policyholder may file suit. Filing a CRN incorrectly may void the bad faith claim, which is why working with an attorney during this step is critical.

How long does an insurance company have to respond to a medical claim in Florida?

Florida law requires insurers to acknowledge and begin investigating claims promptly. While no single statute prescribes an exact number of days for all medical insurance claims, unreasonable delays in processing or paying a valid claim may constitute bad faith under § 624.155. The specific timeline depends on the type of policy, the complexity of the claim, and whether the insurer has requested additional documentation. Persistent silence or unjustified delays are red flags that warrant legal review.

Can I recover more than my policy limits if my insurer acted in bad faith?

Yes. Under Florida Statute § 624.155, damages in a bad faith claim may include amounts that exceed the original policy limits. The statute allows recovery of all reasonably foreseeable damages caused by the insurer's bad faith conduct, including consequential damages, and in some cases, punitive damages. This is one of the strongest protections available to Florida policyholders.

What is the difference between a claim denial and insurance bad faith?

A claim denial is a decision by the insurer that a particular treatment or service is not covered under the policy. It may be based on a legitimate policy exclusion or a genuine dispute over coverage terms. Bad faith occurs when the insurer's conduct in handling the claim falls below the legal standard of fairness and honesty. Denying a claim without conducting a proper investigation, ignoring medical evidence, or using delay tactics to avoid payment may cross the line from a coverage dispute into bad faith territory.

My insurer says my treatment was not medically necessary. What are my options?

A medical necessity denial is one of the most common reasons insurers cite for refusing coverage. If your treating physician recommended the treatment, we obtain the medical records, peer review opinions, and supporting documentation needed to challenge the insurer's determination.

The insurer's in-house review is not the final word. Florida law provides avenues to dispute that determination through internal appeals, external review, and, where applicable, litigation.

Your Insurance Company Has a Legal Team. Now You Need One Too.

Every day that a valid medical insurance claim goes unpaid is a day that medical bills accumulate, treatment options narrow, and stress compounds. Insurance companies count on the complexity of the process to discourage policyholders from fighting back.

They rely on the assumption that most people will accept a denial and move on.

Frankl Kominsky Injury Lawyers is built for these fights. We handle medical insurance disputes throughout South Florida, from Palm Beach County to the Treasure Coast, and we do not collect a fee unless we recover for you.

Call (561) 800-8000 now, any time of day, for a free consultation in English, Spanish, or Creole. If your insurer is not paying what it owes, we step in and change the conversation.