I have a question for the legal minds here regarding the health insurance companies

[ladywnch]

Is there any way to sue the companies and their review doctors who deny treatments prescribed by attending physicians or delay making decisions so that conditions deteriorate to the point where treatments are no longer viable, etc.....is there a way to sue them for negligent homicide or at best depraved indifference? It seems to me that doctors making decision on behalf of their employers so as to receive bonuses and better pay could/should be held accountable. also, are these reviewing doctors required to stay current with advances in medicine as practicing physicians are? If not, is there some way to go after their medical license. I have a hard time believing that the AMA wants to protect these parasitic bastards in their ranks. I realize I could be horribly naive here but is there some way to go after them?????

[debbierlus]

1. No, they can't. I was just reading about this the other day

I wish I had the link to the article.

There is a woman who is trying to sue for the death of her 17 year old daughter who was denied a liver transplant. She went to the company and the employees of the insurer (Cigna, I believe) flipped her off. She was told in court she could sue for the emotional harm caused by the treatment by the employees but she could not sue for the denial of the liver transplant because the Supreme Court already established insurance companies can't be sued for denying care.

It is sick.

[sinkingfeeling]

3. Interesting that the Supreme Court's ruling is based on ERISA. As I read it, it would only

apply to employer-provided insurance policies. Senator Kennedy tried to undo this in 2001.

"Patients should have the right to hold their HMO accountable in court when its negligence causes the injury or death of a patient," Kennedy told Senate colleagues. "No other industry in America enjoys immunity from accountability for its actions, and the insurance industry does not deserve it either."



http://www.latimes.com/business/la-fi-cigna8-2009oct08,0,5656637.story?page=2

[debbierlus]

4. The corporations really run the show, don't they?

Grotesque

[sinkingfeeling]

2. Sure you can file a suit. How successful they are, I don't know.

http://www.shernoff.com/law-firm/faqs.html

Why is it called "bad faith" insurance law?
Thanks to senior partner William Shernoff’s precedent-setting case, Egan v. Mutual of Omaha (1979), insurance companies are legally bound by a "covenant of good faith and fair dealing" in treating their policyholders. When an insurer breaches this covenant, by unreasonably delaying or denying payments, for example, it is acting in bad faith and can be sued for actual and consequential damages as well as punitive damages. Hence, although the term sounds negative, it is a huge plus for policyholders, as it provides substantial recourse against insurance companies that mistreat the people they serve.