Can You Sue for Denied Medical Treatment?
Being denied medical treatment can be life-threatening. Providers are supposed to act in a patient’s best interests but sometimes medical professionals refuse necessary care. Whether it’s a lack of insurance approval or outright negligence, denied treatment can cause serious harm.
The good news is that some situations are grounds for a medical malpractice lawsuit. If you believe you’ve been unfairly denied treatment and want to hold a medical provider accountable, it’s important to understand your rights.
Here’s what you need to know.
The legal duty to provide treatment
The first thing to understand is that healthcare providers aren’t always legally required to provide every service possible. Although the law imposes a duty to treat patients – especially in emergencies – not all treatments fall under this obligation.
Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals that accept Medicare funds are required to provide stabilizing treatment to anyone in an emergency regardless of insurance or their ability to pay. If a provider violates this act, they can be sued.
In a situation where a doctor-patient relationship exists (outside of an emergency), a provider owes their patients a duty of care. In this situation, refusing medically necessary treatment without justification can be considered malpractice.
When denial of treatment becomes negligence
It’s important to understand that not every denial is considered negligence. Courts will look at the provider’s actions first to see if they fall below the accepted standard of care. For example, to be considered negligence, the provider must have failed to act in a way that any reasonably competent professional would in a similar situation.
In addition to denied treatment, denied diagnostics and testing can also be considered negligence if a competent doctor would have run those same tests. Studies show that diagnostic delays contribute to thousands of deaths each year, many of which become wrongful death lawsuits.
Insurance denials vs. provider refusals
It’s crucial to understand the difference between a doctor who refuses treatment and an insurance company that denied reimbursement. Both can have legal consequences but are very different.
Under the Affordable Care Act, patients can appeal insurance denials and get an independent review of their case. If a denial causes serious harm, the patient might be able to sue the insurer. However, if a doctor refuses treatments for reasons that aren’t related to insurance, the liability rests on the hospital or medical provider.
Insurance denials often come from “medical necessity” standards. They seem unfair, but sometimes they’re legal. Common examples include:
- Experimental treatments. Insurers frequently deny coverage for new therapies or drugs that haven’t been approved with long-term study data to back them up.
- Cosmetic vs. reconstructive care. Procedures deemed cosmetic (like certain types of plastic surgery) are often excluded from coverage even when the surgery would improve function.
- Out-of-network providers. Patients who seek treatment from a provider outside the insurer’s network are almost always denied.
- Not medically necessary. Insurers frequently argue that a given treatment isn’t necessary. For example, they often cut off coverage for physical therapy after a certain number of sessions.
Certain groups have additional protections
There are some groups of people that have additional rights because they face unique challenges when attempting to get medical care. For example, prisoners are often denied necessary medical care. The U.S. Supreme Court has ruled that this violates the eight amendment, which prohibits “cruel and unusual punishment.” In this case, prisoners can sue the correctional facility for denied medical treatment.
Workers who are injured on the job are entitled to medical care through workers’ compensation, but valid claims are frequently denied. If care is unjustly denied, workers might have a claim against the insurer or their employer.
Last, vulnerable people and those with disabilities can sue a provider under the Americans with Disabilities Act (ADA) if they are discriminated against and denied treatment. In all of these cases, denied treatment is a civil rights violation.
When to call a lawyer
If you believe you’ve been denied essential medical care, the best time to call a lawyer is now. Medical malpractice lawsuits are time-sensitive and complex. Getting an attorney early will help protect your rights.
Every state has a time limit for filing a lawsuit that typically ranges between one and three years. If you miss this window, you won’t be able to pursue a lawsuit. Book a free consultation as soon as possible. An experienced personal injury attorney will review your medical records and determine whether your denied treatment is grounds for a lawsuit.
Stand up against denied care
Being denied necessary medical treatment is frustrating, but there are laws that protect your rights and allow you to hold medical professionals accountable. If you’ve suffered harm from denied treatment, document your case and speak with an attorney right away.
