Can malpractice be filed against insurance company?

UPDATED: Oct 1, 2022

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Can malpractice be filed against insurance company?

My Mom has been on antidepressants for 30 years for blackouts, the insurance
company decided they were not going to cover them anymore and took her off of
them without weaning her down, now she is in a deep depression and has
contemplated suicide.

Asked on January 30, 2018 under Insurance Law, Pennsylvania


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

No, you cannot file medical malpractice against an insurance company: they are not a medical care provider and do not prescribe drugs or provide care--all they do is pay for certain treatments or not. You mother could still have been on anti-depressants: she simply would hae had to pay for them out-of-pocket, without insurance. The insurer did not change her medical treatment: they simply said they would not pay for a certain course of treatment, but that doesn't prevent your mother from getting that treatment.
What your mother could do is sue the insurer for "breach of contract," for violating their obligations under the terms of her coverage/policy--an insurance policy is a contract. If she can show that under the the terms of her policy, they should be paying for these drugs, she can potentially get a court order compelling them to pay. So she may have recourse, but if she does, it is based on forcing them to honor the obligations in or terms of her insurance coverage.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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