How to Sue a Health Insurance Company

Purchasing health insurance coverage is essentially buying a promise that your health insurance company will be there for you when things go wrong. It provides you with a feeling of security that you will be able to seek the necessary treatment in the event of an emergency and not accumulate substantial medical bills. But what happens when your health insurance company doesn't uphold its promise? You could end up having to pay out of pocket or be forced to forego treatment entirely.

If your health insurance provider denies or delays your claim for coverage, whether in advance of a procedure or afterward when you seek reimbursement, you do not have to simply accept their judgment. You have the right to sue your health insurance company in a small claims court for failing to meet its obligations under the terms of your policy. You can sue your health insurance company in small claims court for a maximum of $10,000.

in small claims instead of a "regular court" comes with three benefits:

Court filing fees are cheaper in small claims than in other courts.
The process is faster in small claims than in other courts, as your hearing will usually be scheduled 30-70 days after you file the lawsuit.
Lawyers are generally not allowed in small claims court, which helps keep the costs of suing low.

This article provides an overview of why you may want to sue your health insurance company, how to file a lawsuit at a small claims court, and how to use DoNotPay to sue your health insurance company at a small claims court for up to $10,000.

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, a clear reason must be given as to why it was rejected. Your insurer cannot send you a letter simply saying, "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	As for-profit businesses, health insurance companies benefit from the money saved, not the claims paid. That's why health insurance companies are often reluctant to pay out, and even if a claim is approved, they may undervalue your claim and offer you less money than your claim is worth. When your health insurance company intentionally makes a "lowball" offer to you, you can sue them in small claims court.

File a Lawsuit Against a Health Insurance Company by Yourself

Ultimately, pursuing a lawsuit against a health insurance company by yourself comes with a significant level of risk. You must prepare for a potentially tricky road and take the time to thoroughly research your legal rights and the elements of the insurance policy in question. With DoNotPay, you don't have to navigate this complex process alone.

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

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.
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.
Once you file your small claims court lawsuit, the next step is to notify your health insurance company that they have been sued by providing them with official court papers. This is called "service of process" (also known as "service").
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.