Can malpractice be filed against insurance company?

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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

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 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.


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