Santa Monica Resident Takes On Conseco Life Insurance Company Over Unpaid Claim

Friday, 19 Apr 2013, 8:58:00 AM

Brenton Garen

Santa Monica resident Pamela Gross is taking legal action against Conseco Life Insurance Company after it denied paying nearly $25,000 in medical and doctor bills after she was treated for a melanoma last year.
Photo by Brenton Garen
Santa Monica resident Pamela Gross is taking legal action against Conseco Life Insurance Company after it denied paying nearly $25,000 in medical and doctor bills after she was treated for a melanoma last year.

When Santa Monica resident Pamela Gross bought a policy

from Conseco Life Insurance Company in 1994, she trusted the major cancer

insurance company would protect her financially should she ever need cancer

treatment.

Nineteen years later, the 63-year-old retired elementary

school teacher and mother of two filed a lawsuit in a case that takes the issue

of bad faith claim delay and denial to absurd levels.

Her lawyers, William Shernoff and Samuel Bruchey, of

Shernoff Bidart Echeverria Bentley LLP, filed the complaint and demand for jury

trial on April 2 at the Los Angeles Superior Court.

In June 2012, Gross was diagnosed with a melanoma in her

upper left triceps. She underwent consultation, treatment, and two surgical

procedures at St. John’s Health Center several weeks later.

The treatment was ultimately successful, but thanks to

Conseco her problems had only just begun.  

After she filed her claim, Conseco required Gross to send

various medical records and other documents, which it repeatedly denied

receiving.

It directed her calls to four separate company offices,

used a 50-year old medical guide to determine the appropriate cost of her

cancer treatment, and denied the malignancy of her melanoma.

Eventually, it paid only a small amount of the claim –

several hundred dollars out of nearly $25,000 in medical and doctor bills – and

has persistently stood by its decision.

Gross, who pays $127 quarterly for the insurance, said

she was given every excuse under the sun before she decided to take legal

action.

“This company is basically telling you to your face: go

sue us,” Gross said. “Most people don’t know how to fight. The point is if you

have a legitimate claim, and you are paying your premiums, then you are

entitled to what you are paying for.”

Conseco Life Insurance Company is a corporation duly

organized under the laws of the State of Indiana with its headquarters in

Carmel, and is licensed to sell insurance in the State of California.

A Conseco spokeswoman said the company was unable to

comment on any situations where there is pending litigation.

Bruchey said his law firm has specialized in suing

insurance companies on behalf of policyholders for more than 30 years.

He said it was becoming more common for insurance

companies to not pay up on legitimate claims.

“We are seeing insurance companies do everything they can

to look for a reason to deny a claim,” Bruchey said. “This case is pretty bad.

I would almost say it’s as bad as it gets. When you consider it involves

somebody who has been diagnosed with cancer. Anybody who has had cancer touch

their family, knows what a terrifying diagnosis that is. Instead of making

things easier for Pam, this company did everything it could to put the burden

of the investigation on her, then came up with what we think are ridiculous

reasons to delay and deny her claims.”

Bruchey said policyholders should speak up if they feel

they have been hard done by.

“People need to remember that just because an insurance

company says that you’re not entitled to any benefits, that’s not necessarily

the end of the story,” he said. “People need to fight for their rights. If it

smells like smoke, there’s probably fire there. In other words, if it doesn’t

seem like the insurance company is treating them fairly, they probably aren’t.

Pamela realized what Conseco was doing wasn’t right and that’s what more people

need to remember to do.”

Bruchey said he was confident in backing his client.

“It’s an outrageous case when you have somebody going

through cancer and the insurance company takes the position ‘well, we know

you’ve got melanoma, but that’s not necessarily cancer,’” he said. “When Pamela

told her doctors that, they laughed because it not just cancer, but it’s one of

the most deadly kinds of cancer.”

Conseco has 30 days from the filing of the suit to

respond to the claims.

Related

Mirror columnist Tom Elias: Lawsuit Targets Companies Selling What Lawyers Call 'Junk' Health Insurance

Copyright © 2011 by Santa Monica Mirror. All rights reserved.