Can I sue my health insurance company?

by Anonymous
(USA)

After more than 3 years with a Comprehensive Pain Management doctor, who discharged me in May 2012, I filed a grievance against him and his Medical Assistant. I also gave a copy of my complaint to my primary doctor, psychiatry/neurology and mailed it to my HMO to be placed in my file as well as other agencies.

My insurance company in June approved an over-ride for an out of network doctor. As of today, neither the insurance company nor my primary doctor will prescribe my medication for chronic spinal pain injuries I've had for more than 25 years. I had to go to the hospital for a two day supply.

Between the insurance company and my primary doctor's staff, I am caught in the middle. I am constantly being pawned off or told "It's their responsibility" and it is causing me undue stress and high anxiety. Meanwhile, I have made every effort to look for a doctor.

With the assistance of a case manager from my insurance company we found a doctor a reasonable distance from my city. Now the insurance company is saying, "What are you talking about?" and denying I see him.

My previous doctor, who I have seen twice in 4 years (I see the PA monthly), tells me "I have only 5 minutes to spare" because "I have other patients to see." I scheduled an appointment to see her again in September.

Can I sue for Professional Malpractice based on my doctor's negligence as well as my health insurance company? Any information you can give would be appreciated. Thank you.

Visitor Question:
Disclaimer: Information provided in our response is NOT formal legal advice. It is generic legal information based on the very limited information provided. Under no circumstances should the information in our response, or anywhere else on this site be relied upon when deciding the proper course of a legal matter. Our response does NOT create an attorney-client relationship. Always get a formal case review from a licensed attorney in your area.

ANSWER for "Can I sue my health insurance company?":

Anonymous (USA):

You have a legal right to sue the doctor for malpractice. If you believe his or her action, or in your case inaction, was medically inappropriate and as such caused you additional injuries or exacerbated your present injury, you may have a case.

Of course, believing medical malpractice and proving it are at the opposite ends of the "legal reality" spectrum. To prevail in a medical malpractice case you will first need a top-notch personal injury attorney with expertise and experience in medical malpractice cases. Cases like these are hard-fought by doctors and their insurance companies. You will need a good lawyer and some very credible documented proof of the malpractice.

Contact a personal injury medical malpractice attorney. Most won't charge any fee for an initial office consultation. You never want to attempt self-representation in a medical malpractice case. Doing so is a recipe for disaster.

To prevail in a lawsuit against the insurance company you will have to prove by a "preponderance of the evidence" that the insurance company acted in "Bad Faith" in denying your claim, or that it in other ways thwarted your legitimate claims for deserved coverage. Bad Faith lawsuits against insurance companies are the most prevalent types of cases.

Bad Faith lawsuits should also not be filed by a lay-person. Like medical malpractice claims, insurance companies aren't easily persuaded. You will have to find an experienced civil attorney who knows her way around bad faith insurance law.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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