How To Sue a Health Insurance Company

Health insurance ensures treatment security during emergencies, but if the provider fails, you can sue in small claims court for up to $10,000.

It’s quicker, cheaper, and lawyers are usually not involved, making the process affordable and accessible.

Sue a Health Insurance Company
How to sue a health insurance company: Photo source (Sapling)

Reasons to File a Lawsuit Against a Health Insurance Company

You can sue your health insurance company for several reasons, including:

Sue a Health Insurance Company for Denying a Legitimate Claim Without Giving a Reason Health insurance companies should always give a reason for denial of claims. If your insurance company denies your claim, they must provide a clear reason for the rejection instead of sending you a vague letter stating, “your claim has been refused.” So, if your insurance company has denied a valid claim without giving any reason whatsoever or has denied your claim for an invalid reason, you may file a lawsuit against your insurance company in a small claims court.
Sue a Health Insurance Company for Unreasonable Payment Delays Even in cases where your claim is not denied, your health insurance company could unjustly delay payment of your claim. They may continue to ask for additional documentation, even when they don’t really need it, or find other ways to make completing the claims process as difficult for you as possible. Their hope in these cases is that you will eventually drop the claim altogether, saving the insurance company money.
Sue a Health Insurance Company for Offering Less Money Than a Claim is Worth Health insurance companies prioritize saving money over paying claims. They may undervalue approved claims, offering less than deserved. If you receive a lowball offer, you can sue them in small claims court.

File a Lawsuit Against a Health Insurance Company by Yourself

Suing a health insurance company alone is risky and requires thorough research.

DoNotPay can help you navigate the complex process, providing valuable assistance and support.

Here’s a step-by-step process for suing your health insurance company in a small claims court on your own:

  1. The first step in filing a lawsuit against your health insurance company is to draft and send a demand letter to your health insurance company explaining the scope of your damages and why the insurance company is responsible for these damages. It is essential to include all of the evidence and documentation you need to make a strong case.
  2. Fill out the court forms provided to you by the court and file your complaint. You can file your case in person, by mail, or online.
  3. After filing your small claims court lawsuit, the next step involves notifying your health insurance company by serving them official court papers. This legal process is known as “service of process.”.
  4. Prepare to make your case and show up for your court date. To build your health insurance suit, it’s best to keep copies of any correspondence between you and the insurer and careful notes from any conversations you have with the adjuster.

Dangers & Issues With Filing a Lawsuit by Yourself

Disputes with health insurance companies are often complex, and your rights may depend on provisions in your health insurance contract as well as the laws of your resident state.

There are also time constraints and other requirements that the average person with no legal training may have trouble navigating.

You may miss a deadline or forget a crucial piece of paperwork, which could be all it takes for your health insurance company to file a motion to dismiss, and the case could be dead before it ever really gets off the ground.

So filing a lawsuit against your health insurance company on your own is not the best idea.

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