Plaintiff Sues N.J. Health Insurer Over Failure to Pay Claims

A suit, initially filed by a patient in state court, was removed to the District of New Jersey on Thursday. The case was brought against Salvasen Health, Blackhawk Claims Services, and unknown individuals and corporations. The state court complaint seeks a trial by jury and favorable judgment regarding the disputed insurance claims.

The defendants provide healthcare insurance to residents of New Jersey and engage in business with medical providers in New Jersey.

In June of 2021, the plaintiff called the defendants, with whom he held a policy, to inquire about why she received bills from five providers whose claims were denied by the defendants despite the insurance coverage being verified by the providers prior to the rendering of services. The defendants explained that they had dropped the plaintiff from their coverage in March, just three months earlier. When the plaintiff protested that she did not want to be dropped, the defendants simply offered her a refund for four months’ worth of premiums.

A month later, the plaintiff received the aforementioned refund which totaled $1,128.00. The plaintiff made continued efforts to get in contact with the defendants but had difficulty. In October of 2021, they informed the plaintiff that they processed two of the unpaid claims.

The complaint explains that the plaintiff “has tens of thousands of dollars in unpaid medical bills for services that were preapproved by Defendants,” causing the plaintiff to pay some of the bills out of pocket. The plaintiff, the complaint says, is still receiving bills for services that were supposed to be covered by the defendants.

The complaint seeks equitable and legal relief for breach of express contract, breach of implied covenant of good faith and fair dealing, breach of implied contract, fraud, fraudulent inducement, detrimental reliance, and a violation of the New Jersey Consumer Fraud Act. The plaintiff is seeking compensatory damages of no less than $200,000, payment of all outstanding claims and bills in addition to any received in the future, damages for humiliation and mental and emotional distress, statutory and punitive damages, litigation fees, and any other relief deemed proper by the court.

The plaintiff is represented by Hyderally & Associates, P.C.