Know your rights when in a dispute with your health insurer
Recently, a question was submitted to The Daily Breeze about suing a health insurance company for emotional stress. The patient was being seen in the emergency room after fainting and was having some tests done. The patient’s health insurance company told the hospital that the policy had been canceled because the premium wasn’t paid.
The patient was forced to leave the emergency room in order to get the problem solved. It had been the health insurance plan who had been mistaken. It took more than two weeks before the woman could get back to see a doctor. This was upsetting, and ended up causing the patient further medical issues. Since that time, the patient learned that the health plan is an ERISA plan and that the insurance company cannot be sued for emotional distress. The patient wanted to know if this was the correct information.
Many of the health insurance plans in force today were formed under the Employee Retirement Income Security Act of 1974. Claims that involve a denial of benefits have to be filed in federal court. Normally, tort damages, or those for bad faith, emotional distress and similar things aren’t recoverable. This was because ERISA preempted state laws.
The statute regarding the preemption devise might not apply if the health insurance company violated common industry practices. You claim could be exempt from ERISA or be subject to modification.
These can be very complex issues and the advice and judgment of an experienced ERISA attorney can prove invaluable. You don’t want to miss out on benefits you deserve.
Source: The Daily Breeze, “What are my rights in a dispute with my health insurer?,” Ron Sokol, Sep. 27, 2016