Health Insurance Litigation – Doctors and Lawyers

There is nothing quite as confusing as combining insurance and litigation. Insurance can be a tangled maze of conditions, exclusions, riders, federal and state regulations, plan details, and paperwork. When you involve lawyers and more insurance carriers into the mix, the maze gets even more tangled. For example, one of the more common forms of health insurance litigation involves subrogation. You are involved in a car accident and your medical insurance company covers your medical expenses while your automotive insurance company covers your damaged property. In actuality, your car insurance company is responsible for medical payments relative to the accident. Therefore, your health insurance company could file suit against your car insurance company for reimbursement.

In such instances, medical insurance litigation can turn into a real mess if later the other driver is determined to be at fault for the accident. Then, not only are your insurance carriers arguing over who has to reimburse whom for what, but they can then both file suit against the other driver and their insurance company. Three insurance companies arguing over coverage and necessary reimbursement for a single event invariably will involve lawyers, witness statements, police reports, and a whole lot of paperwork.

On the other side of the spectrum, medical insurance litigation can also involve just you and your provider. Denial of coverage and the associated appeals process often leads individuals with no other recourse than to hire an attorney and begin the process of litigation. Litigation does not always require filing a law suit. In some instances, mediation by a third party can help insurers and the insured reach an amicable settlement without requiring a court date. However, even this type of litigation will usually involve lawyers to handle the negotiation and mediation process to ensure both parties’ rights are protected.

The unfortunate result of mixing doctors and lawyers for health insurance litigation is the high cost and expense associated with untangling the legal mess. These expenses for litigation are passed on to the community at large by way of increased premiums and more stringent qualifying guidelines to get health insurance. The insurance industry, whether health insurance, life insurance, auto, or home, is based entirely on risk. That risk includes the company’s risk for future litigation. As such, consumers who are deemed higher risk, including higher risk for litigation, pay higher premiums. The more risk of litigation an insurance company perceives, the less chance consumers have of qualifying for coverage.If you need assistance in locating particular coverages at a pre-determined price, we can help save 50% on health insurance.

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