Two individuals suffering from limb loss sued United Healthcare, a health insurance company, claiming that the company automatically denies claims for prosthetic limbs without investigation, in violation of the Employee Retirement and Security Act of 1974. The individuals are seeking compensation for their prosthetic limbs and are asking that the company change its policies going forward.
The plaintiffs brought the case on behalf of themselves and others whose claims for prosthetic arm and leg devices have been denied by United Healthcare on the basis that the requested devices “do not meet the minimum specifications of the enrollees needs. United Healthcare has developed policies about what it will and will not cover. One policy involved prosthetic limbs, and states “If more than one prosthetic device can meet the member’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications of the member’s needs.”
According to the lawsuit, pursuant to its policies, United Healthcare has systematically denied claims for prosthetic arm and leg devices without assessing or determining the claimant’s functional needs, without assessing or determining how a prosthetic device meets the “minimum specifications” of the claimant’s needs, and without ascertaining or identifying if an alternative device will meet the “minimum specifications” of the claimant’s needs.
If you have had your claim for a prosthetic limb denied by United Healthcare, call me, Conal Doyle, Amputation Attorney. I am not only a personal injury attorney, I’m also an amputee, and I am currently working on several cases against insurance companies. Call me today at 310-385-0567.