complex tort litigation | Managed Care Abuse

A voice for those denied medically necessary care.

Managed care abuse occurs when an insurance company delays or denies a patient’s medically necessary care despite the recommendation of a doctor or other health professional.

Overview

Managed care abuse occurs when an insurance company delays or denies a patient’s medically necessary care despite the recommendation of a doctor or other health professional. Delays and denials often happen because the adjuster reviewing a claim is not a trained medical professional and, worse, is sometimes incentivized to deny claims. Most importantly for the patient, a delay or denial can lead to aggravated health problems or additional injuries.

State and local government employees like firefighters, teachers, and police officers, the self-employed, and small business owners are the most vulnerable to managed care abuse because they do not have access to the same administrative remedies as people who are insured by group plans obtained through their private employers. Thus, they often must seek legal counsel and challenge their insurer’s delays and denials of medical care through the courts.

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Past Cases

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Chipps v. Humana Health Insurance Co. of Florida

Chipps v. Humana Health Insurance Co. of Florida (Cir. Crt., Palm Beach Cnty., Fla.): Cohen Milstein represented a family in this managed care abuse case after Humana wrongfully denied physical and occupational therapy for a 6-year-old child with cerebral palsy. After six years of litigation and a four-week jury trial, the jury awarded the Chipps family more than $1.03 million in compensatory and $78.5 million in punitive damages. This landmark lawsuit uncovered widespread fraud at Humana, including the payment of bonuses to physicians and nurses based on the number of medical claims they denied each month.

Gillig v. United Healthcare

Gillig v. United Healthcare (Cir. Crt., Palm Beach Cnty., Fla.): Cohen Milstein represented Philip Gillig in this Managed Care Abuse lawsuit against United Healthcare for failing to provide Mr. Gillig with timely access to medical care and treatment, thereby failing to administer medically necessary benefits, despite Mr. Gillig’s declining condition. As a result, Mr. Gillig fell into septic shock and suffered significantly.