This case involves an insurance bad faith claim levied against a medical insurance provider. The plaintiff, a middle-aged woman who hadn’t received medical coverage in many years, applied online for a policy to be effective the next day. The day after that, the plaintiff suffered a severe diabetic attack during which her blood sugar level rose to 1000. Because the diabetic attack was so close in time to when she set up coverage, it immediately went under review with the insurer. She was denied coverage because the insurance company believed it was clear that she was highly symptomatic in the five years prior to the policy, and because a “reasonable person” would have sought medical care in this scenario. The plaintiff sued the insurance provider, claiming they acted in bad faith to deny her coverage. An expert was sought review the records and insurance filings to determine if it was reasonable to deny coverage.
Question(s) For Expert Witness
1. Please briefly describe your experience/familiarity with insurance bad faith as it relates to similar claims as the one in this case.
Expert Witness Response E-044264
An insurer's duty is to fairly and reasonably review policy language with an eye toward providing coverage, unless policy terms do not apply to the situation at hand or one or more exclusions or conditions preclude coverage. Whether that insurer's duty is fulfilled is determined by the reasonableness of the insurer's actions in reviewing all aspects of the case and treating the putative insured fairly in carrying out that duty. Here, the putative insured presented via online application for next day coverage, as a person without medical treatment or coverage for years. However, she had personal awareness of symptomatology consistent with a diabetic condition. It is not bad faith to question coverage given her history and the diabetic attack one day after inception. An insurer acts reasonably and in good faith in forming an opinion that a putative insured under these circumstances was highly symptomatic in the five years prior to inception, if in doing so, it reasonably concludes those symptoms existed. Moreover, it is good faith to expect that a "reasonable person" would have sought prior medical treatment given these circumstances.
About the author
Victoria Negron
Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.
Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.
Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.
