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How to Sue My Health Insurance Company

“To sum it up…”

  • Begin the process by filling a formal appeal of the decision issued by the health insurance company
  • Consult with an attorney
  • Go through pre-litigation forms of resolution that involve you and your lawyer
  • Failing all of this, being the process of filing a formal lawsuit against the health insurance company

You have health insurance for a reason. You and your family members need coverage for a wide variety of medical ailments when they occur. It is designed to give you the peace of mind that you need and to ensure that you do not have financial struggles because of an unexpected illness or injury. This is why it is more than a bit frustrating when you encounter problem after problem in trying to get your health insurance provider to give you the benefits that are rightfully yours. When that happens, you might be left with no other alternative than to sue them.

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Filing a lawsuit is rarely anybody’s idea of a fun day at the park. It is often a long and drawn out battle where it seems that only the fittest survive. This is exactly what the insurance companies are counting on, so you will just need to persevere and allow the justice system to run its course if you have truly been wronged by your health insurance provider.

If you do have a dispute with your health insurance company, the filing of a lawsuit should not necessarily be the first item on your agenda. You will want to go through a series of formal procedures in order to gain resolution and provide much more weight to your lawsuit, should it come to that.

The ideal situation will be to arrive at an agreeable settlement to the issue outside of court. Failing that, a lawsuit is certainly within your rights.

Begin With Various Forms of Pre-Litigation Resolution


Just like most areas in life, you want to have your ducks in a row before rushing out to sue your health insurance company. Remember that the ultimate goal is to get compensated for the medical services that you are rightfully insured to receive.

If you are able to do that without a lawsuit, that is ideal as it will get you the treatment and financial compensation that you need to keep going. To begin that process, you will want to go through a series of steps to appeal the negative decision that has been handed down by your health insurance company. That being with the following three processes:

  • Conduct and initial internal review with the insurance company
  • Go a step further by having a second internal review with the insurance company
  • Engage the services of an independent consultant to conduct their own external review

These three steps in the process are meant to encourage the health insurance company to wake up and see the facts in your case. The hope is that your appeal will be successful and that the claim will be accepted in the end. If not, then you will want to begin the process of bringing a lawsuit against the insurance company.

Suing Your Health Insurance Company


While it might seem to be daunting for you as a private individual to bring a lawsuit against such a large corporation, it is nonetheless within your legal rights to do so. In fact, if the external review of your appeal brings an undesirable result, you might be left with no alternative other than a formal lawsuit.

Keep in mind that each state has its own procedure for bringing a lawsuit against an insurance provider, with some not allowing such an eventuality at all.

You will want to look the policy itself and read the fine print in order to do so. Since that is never a pleasant task, consult with a lawyer for the best advice.

As you begin to prepare yourself to contact a lawyer in your area, you should have the following four items in your possession in order to streamline the process:

  • Have a detailed copy of your insurance policy available
  • Maintain a written record of all communications you have had with your insurance company to this point and provide that your prospective attorney
  • Have original documentation of all denials to your claim issued by your health insurance company
  • Maintain a file detailing all documents that you receive during both the internal and external review processes

Having these items will help give your lawsuit merit, and will go a long way towards helping your lawyer know exactly which direction to take the lawsuit. There are some things to keep in mind should you go through with filing a lawsuit. The first begins with the fact that your insurance company may very well send any premiums you have paid back to you. Along with this, they might send you some documents releasing them from any further obligations.

Do not sign any documents sent to you once you have retained a lawyer. If you do receive any correspondence in the mail, forward those immediately to your attorney.

In addition, direct any attempts on behalf of the insurance company to communicate with you directly to your attorney.

As you start looking into the possibility of suing your health insurance company, you will want to read and make sure that you understand any applicable bad faith insurance laws in your state. As you hire a lawyer, make sure that he or she is qualified and experienced specifically in this area of the law.

Lawsuits made against health insurance companies who have violated bad faith laws will typically be accepted on a contingency-fee basis. This means that you will only pay your attorney when a settlement is reached in your favor. Make sure you understand the provisions of this and their percentage of the settlement that your attorney will receive in the eventuality that you win the lawsuit.

Things to Keep in Mind When Suing Your Health Insurance Company


Most insurance related claims are referred to as bad faith insurance claims. This is a claim that is made against your insurance company. They typically result from the insurance provider failing in one of the following three areas:

  • Failure to respond to a legitimate claim for covered health related services in a timely manner
  • Declining a claim outright, or refusing to enter into a fair settlement
  • Failure to conduct a thorough internal investigation

When you file a bad faith lawsuit against your insurance company, the onus is on the provider to demonstrate that it responded appropriately and in your best interest as their client. In essence, the insurance company must turn around and demonstrate to the court that they acted in good faith.

What happens once the lawsuit is filed?


There are many things that will occur in the aftermath of a lawsuit. You will likely hire a lawyer, as will the insurance company. Make sure that your lawyer specializes in this are of the law. Both sets of lawyers will then set out to investigate all of the facts related to the case and enter into a period of discovery.

Similar to what you might have seen on courtroom television dramas, this involves both sides sharing all pertinent documents with the other. You will also likely be called upon to give a deposition, which is your account of the facts. You will be asked a series of questions and be expected to provide truthful responses.

Keep in mind the following key points as well:

  • If your case cannot be settled before court, you will likely be called as a witness and be asked to testify in court
  • A lawsuit against a health insurance company can take a few years to fully resolve. You will just need to be patient throughout the process. An outcome will eventually arrive.
  • Trust your lawyer to take care of your case and provide you with regular updates as to its status
  • If you can’t afford a lawyer, keep in mind that many will accept your case on a contingency fee basis if they feel that it has merit.

This is basic information relating to suing your health insurance company. If you have been wronged in some way and you believe that you have a case, contact an attorney for help and be advised on the best course of legal action moving forward.

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  1. http://guides.wsj.com/health/health-costs/how-to-appeal-a-health-insurance-denial/?mg=id-wsj
  2. http://www.badfaithinsurance.org/reference/General/0007a.htm
  3. http://uphelp.org/pubs/what-expect-when-you%E2%80%99re-suing-insurance-company