Your health insurance company denied your claim. Collins & Collins, P.C., represents individuals and families in Albuquerque and throughout New Mexico whose health insurance claims were wrongfully denied or delayed. Our attorney Rebekah Wright leads this practice, bringing graduate-level training in Health Law and Policy to every case. We handle medical insurance bad faith under NMSA 1978 § 59A-16-20, including ERISA and non-ERISA claims, prior authorization abuse, and mental health parity violations. No fee unless we recover for you. Call (505) 242-5958.
407 7th St NW Albuquerque, NM 87102
info@collinsattorneys.com
Your health insurance company denied your claim. Maybe they called the treatment experimental. Maybe they said it wasn’t medically necessary. Maybe they stopped responding entirely. Whatever their reason, you are now facing a serious medical situation without the coverage you paid for.
That is medical insurance bad faith. It is actionable under New Mexico law.
Our Albuquerque medical insurance bad faith lawyers at Collins & Collins, P.C. represent individuals and families throughout New Mexico whose health insurance claims were wrongfully denied or delayed. Our attorney Rebekah Wright leads this practice alongside our civil rights and institutional accountability work. Her graduate training in Health Law and Policy at the University of Houston Law Center gives our team depth in the regulatory framework governing New Mexico insurers.
Our team has spent years litigating against powerful institutions that prioritize cost over care. Medical insurers are no different. We handle these cases on a contingency fee basis. No fee unless we recover for you.
If your health insurance claim was denied or delayed, call (505) 242-5958 or request a no-obligation case review today.
Medical insurance bad faith occurs when an insurer wrongfully withholds, obstructs, or underpays claims for treatments covered under your policy. Under NMSA 1978 § 59A-16-20, New Mexico’s Unfair Claims Practices Act, every health insurer must investigate claims promptly, provide written explanations for denials, and attempt in good faith to settle when liability is reasonably clear. When an insurer fails those duties, the harm goes beyond finances. Denied care can cost you your health, your function, or your life.
New Mexico policyholders most often encounter bad faith in these forms:
When an insurer’s conduct crosses from a coverage disagreement into a legal violation, our team litigates insurance bad faith cases in Albuquerque and throughout New Mexico.
When your health insurer wrongfully withholds necessary care, the consequences do not stay contained to one area of your life.
When your child is the one affected, our team pursues every available remedy. Denied pediatric care carries the same legal weight as any other bad faith denial.
If your insurer has denied or obstructed your care, call (505) 242-5958 or request a free case review today.
Denial of Coverage for Pre-Existing Conditions: Under the Affordable Care Act, most health plans are prohibited from denying coverage based on pre-existing conditions. If your insurer rejected your claim on those grounds, that denial may have no legal basis.
Failure to Pay for Emergency Care: Federal law requires insurers to cover emergency services without prior authorization. If your insurer denied your emergency care claim by arguing the situation was not urgent enough, that position warrants legal review.
Step Therapy and Fail-First Protocols: Insurers sometimes require you to try and fail on lower-cost treatments before approving the medication or therapy your physician prescribed. When that sequence is medically inappropriate for your condition, New Mexico’s bad faith law provides grounds to challenge it.
Retroactive Coverage Rescission: Some insurers approve your treatment and then rescind coverage after care has been provided. Rescinding coverage after care was authorized and received, outside of fraud, is a recognized form of bad faith. If your insurer rescinded your coverage without a legal basis, you may have a viable claim.
A wrongful denial does not just cost you the benefits you were owed. Depending on whether your plan is governed by ERISA or New Mexico state law, you may be entitled to recover significantly more than the denied claim itself.
If your plan is an individual or government employer plan not subject to ERISA, New Mexico’s bad faith law applies fully. Recoverable damages include:
If your plan is an employer-sponsored ERISA plan, recovery is limited to the benefits owed, plus interest, and discretionary attorney’s fees. Punitive damages and emotional distress damages are not available under ERISA. For state court cases, our overview of punitive damages in New Mexico explains when and how these damages are pursued.
We handle these cases on a contingency fee basis. No fee unless we recover for you.
Several New Mexico statutes impose enforceable obligations on your insurer, not general consumer protections but specific legal duties with consequences for violations.
The statute of limitations for a medical insurance bad faith claim under New Mexico state law is four years from the date of the wrongful denial. For ERISA plans, different limitations periods apply. An overview of bad faith insurance law in New Mexico covers both frameworks in greater detail.
The most important question in any medical insurance bad faith case is whether your health plan is governed by federal law or New Mexico state law. The answer determines what you can recover.
If you receive health insurance through a private employer, your plan is almost certainly governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (ERISA). Federal law preempts state bad faith claims for employer-sponsored plans. Your recovery is limited to benefits owed, plus interest, and attorney’s fees in some circumstances. Punitive damages and emotional distress damages are not available. Not all health plans fall under ERISA. New Mexico’s bad faith law applies fully to:
For these plans, NMSA 1978 § 59A-16-20 governs your claim. Available damages include punitive damages, emotional distress compensation, and the benefits wrongfully withheld. The plan documents will answer this question within minutes of review.
Call (505) 242-5958 before drawing conclusions about your remedies.
Call (505) 242-5958 before either deadline expires.
At Collins & Collins, P.C., our lawyers know how to take on large medical insurance companies. Here is how we handle these cases:
Collins & Collins, P.C., handles medical insurance bad faith cases across New Mexico. Our attorney, Rebekah Wright, brings graduate-level training in Health Law and Policy to every case, giving our team regulatory depth that general bad faith practices rarely have.
Schedule a no-obligation case review with our team today.
Collins & Collins, P.C. represents medical insurance bad faith clients throughout New Mexico, not just in Albuquerque and Bernalillo County. We serve clients from Santa Fe, Rio Rancho, Las Cruces, Farmington, Roswell, and communities across the state, including policyholders on ACA marketplace plans through BeWellNM, New Mexico state employees, public school teachers, and individuals on private plans who have exhausted their insurer’s internal process.
If your health insurance claim was denied or mishandled anywhere in New Mexico, our New Mexico insurance bad faith attorneys are ready to help.
Call (505) 242-5958 for a free case review.
There is no fixed timeline. Non-ERISA state court cases move through discovery, expert review, and either settlement or trial in the Second Judicial District Court. ERISA federal cases are often decided on the administrative record without a full trial, which can shorten the process. Cases that proceed to trial or federal court review take longer than those that settle. We give you a realistic timeline during the initial case review.
The strongest cases are built on the insurer’s own documents. Under NMSA 1978 § 59A-16-20, every denial must have a reasonable basis. When the insurer’s internal documents contradict that basis, the denial becomes actionable. Key evidence includes:
We request your complete claim file as the first step in every case evaluation.
Yes, depending on your plan type. For non-ERISA plans, you can pursue a civil bad faith claim in New Mexico state court under NMSA 1978 § 59A-16-20. Recoverable damages include compensatory damages, punitive damages, and attorney’s fees. For ERISA plans, your claim is filed in the U.S. District Court for the District of New Mexico, and recovery is limited to benefits owed plus interest. We identify your plan type and the correct court during the initial case review.
An internal appeal asks your insurer to reconsider its denial through its own review process. A bad faith claim is a civil lawsuit alleging your insurer violated New Mexico law or federal law. For ERISA plans, exhausting the internal appeal is legally required before filing a lawsuit under 29 C.F.R. § 2560.503-1. For non-ERISA plans, completing the appeal creates a record that strengthens your bad faith claim. The two processes are not mutually exclusive.
No. Filing an internal appeal strengthens your bad faith claim in most cases. The appeal creates a written record of your insurer’s position and how it responded to your physician’s documentation. For ERISA plans, the administrative record developed during the appeal is the primary record federal courts rely on. For non-ERISA plans, a denied appeal demonstrates that the insurer had multiple opportunities to correct its conduct and refused.
Your insurer’s disagreement with your physician does not make the denial valid. Under NMSA 1978 § 59A-16-20, every denial must have a reasonable basis. Denying coverage based on a desk review by a reviewer who never examined you, or ignoring your treating physician’s documentation, is a recognized indicator of bad faith. If the insurer’s position cannot withstand scrutiny, your denial may be actionable.
A utilization review denial says your requested treatment does not meet the insurer’s medical necessity criteria. A coverage denial says the treatment is excluded from your policy entirely. Both can constitute bad faith if the denial lacks a reasonable basis. Utilization review denials fall under NMSA 1978 § 59A-22B timelines. Coverage denials are evaluated under your policy language and NMSA 1978 § 59A-16-20. Our team evaluates both before advising on a course of action.
Your health insurer denied your claim. New Mexico law gives you the right to challenge that denial, but only within a limited window. The sooner we review your case, the more options we can pursue on your behalf.
Our team is available at our Albuquerque office at 407 7th St NW, Albuquerque, NM 87102, serving clients throughout New Mexico. Call (505) 242-5958 or complete our no-obligation case review form today. There is no fee unless we recover for you.
Past results do not guarantee similar outcomes. Every case is different, and the value of any claim depends on its specific facts.
If you or a loved one has been harmed by negligence, medical malpractice, or injustice in New Mexico, Collins & Collins, P.C. is here to fight for the compensation you deserve. Your first conversation is always free and confidential.
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Past results do not guarantee any future outcome, and every case is different.