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Do we have a cause of action against a Health Insurance Company that tells us in writing that we have coverage than denies a claim. and later admits in writing that an employee made a mistake on the coverage dates.

Submitted: 436 days and 19 hours ago.

Category: Legal

Value: $15

Status: AWAITING CUSTOMER ACTION

Answer

Probably not unless you have damages. They made a mistake. They were negligent in that mistake. However, you would have to show damages. If they did not pay the bill even after recognizing the mistake, then you would have damages. If you can show you went on that date because of the coverage, then you relied on them and then you would have damages. But, if they paid the claim after recognizing the mistake, you have no damages.

Also, if it is an employer sponsored health insurance plan it is called an ERISA plan and you have almost no ability to sue them.

Good luck.

Accepts:
Expert:	Steinlaw
Pos. Feedback:	99.3 %
Answered:	9/12/2008

Attorney

8+ years as an insurance adjuster, 5+ years as a personal injury and consumer law attorney

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Do we have a cause of action against a Health Insurance Company that tells us in writing that we have coverage than denies a claim. and later admits in writing that an employee made a mistake on the coverage dates.

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