September 21, 2020 Breaking News, Latest News, and Videos

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

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

in News
Related Posts

4.6 Quake Felt in Santa Monica

September 19, 2020

September 19, 2020

4.6 magnitude quake recorded Friday night By Sam Catanzaro A 4.6 magnitude earthquake struck the San Gabriel Valley Friday sending...

Edify TV: Miramar Santa Monica Redevelopment

September 18, 2020

September 18, 2020

The Santa Monica skyline may look different in the future with a major redevelopment of the Fairmont Miramar Hotel &...

‘Fresh Prince Of Bel Air’ Mansion For Rent On AirBnb

September 18, 2020

September 18, 2020

Today on Westside Cribz, 30th anniversary of “The Fresh Prince of Bel Air” Airbnb is renting out the mansion for...

SMMUSD Kindergarten Enrollment Down 20% : Santa Monica Beat – September, 17, 2020

September 17, 2020

September 17, 2020

Local news and culture in under 5 minutes. * SMMUSD Kindergarten Enrollment Down 20% * As Covid-19 Cases Drop Will...

Edify TV: Sit-down Dining Safety?

September 17, 2020

September 17, 2020

Despite a recent CDC report stating the risks of in-person dining, many Westside restaurant patrons feel the experience is safe....

Sur La Table Closing Santa Monica Location

September 16, 2020

September 16, 2020

1930s building listed for lease By Sam Catanzaro Sur La Table, the popular kitchenware retail chain, is closing its downtown...

Death by Suicide at Santa Monica Place

September 16, 2020

September 16, 2020

Man dies by suicide Wednesday morning By Sam Catanzaro A man died by suicide at Santa Monica Place mall Wednesday....

Santa Monica Partners With Local Elementary Schools to Provide More Outdoor Spaces

September 16, 2020

September 16, 2020

Playground Partnership agreement goes live By Toi Creel The City of Santa Monica and local schools are working together to...

Charges Filed Against Man for Sexually Assaulting Elderly Victims

September 16, 2020

September 16, 2020

Juan Victor Mendoza faces four felony charges Prosecutors have filed charges against a man for sexually assaulting elderly victims at...

COVID-19 Continues to Decrease in County but Air Quality Reducing Testing

September 15, 2020

September 15, 2020

Smoke advisory in effect through Wednesday By Sam Catanzaro While COVID-19 cases continue to decrease in Los Angeles County, health...

Edify TV: Westsiders Working out Amid Poor Air Quality

September 15, 2020

September 15, 2020

With poor air quality due to wildfire smoke, local health officials are urging the public to avoid outdoor activity but...

COVID-19 Could Have Been in Area as Early as Last December

September 15, 2020

September 15, 2020

UCLA study reports significant increase in coughs and acute respiratory failure prior to first official cases of COVID-19 By Sam...

Willy California Wants Men to Rethink Their Closet

September 15, 2020

September 15, 2020

Local clothing line reimagines athleisure By Toi Creel With ranges in styles for men’s clothing from suits and professional clothing...

Police Searching For Robbery Suspects: Santa Monica Beat – September, 14, 2020

September 14, 2020

September 14, 2020

Local news and culture in under 5 minutes. * Police Searching For Robbery Suspects * Should School Board Representatives Have...