Prosthetic Limb Denials: What Happens if Your Insurer Refuses to Act in Good Faith?

Advances in prosthetic limbs have given amputees a chance at resuming a higher quality of life. However, some insurers have denied coverage for prosthetics for bad faith reasons.

Losing a limb can be a devastating experience. However, modern medicine has advanced to the point where amputees can recover much of their former functionality with prosthetic limbs. Decades ago, people with older prosthetic limbs struggled to do many of the activities they loved (such as playing sports or hiking) because those older devices were less natural, less comfortable and did not move in a life-like manner.

Today, however, cutting-edge prosthetic limbs with microprocessors can help wearers walk fluidly and provide much greater stability. This can allow them to live a life that is close to the one they enjoyed before they required an amputation.

Unfortunately, insurers have not always acted in good faith when asked to provide coverage for these advanced prostheses.

Despite the myriad advantages offered by advanced prosthetic limbs, some insurers have immediately denied claims, consigning policy holders to a lower quality of life with an inferior prosthetic.

How the Law Helps People Get Access to High Quality Prosthetics

Our law firm has helped amputees who have been denied coverage for advanced prosthetics. One example: Blue Cross Insurance denied a claim for an advanced “C leg” prosthetic by claiming the technology is “experimental and investigational.” However, these limbs have been recognized as a standard device for more than a decade and are offered to all U.S. soldiers who require an amputation.

Our firm also represented a teacher who requested an advanced, myoeletric artificial arm because it provided much greater dexterity – something she needed to write on blackboards and fulfill other core parts of her job.

A third client of our firm, an actor and father of young children who required an arm amputation, was initially given a prosthetic with a hook for a hand. His insurer denied his claim for an advanced myoeletric arm. With the more primitive prosthetic, this man could not secure acting jobs or play with his children.

In these cases, settlements with the insurer were secured providing access to the advanced limb. Our firm was also able to secure an additional financial payout for damages. In the latter two cases, damages of more than $400,000 were agreed upon.

Fighting Bad Faith Denials

While insurers such as Blue Cross characterize the limbs as experimental and unnecessary, the truth is they are well-established and offer vastly better performance. Because they are more expensive, however, these claims sometimes are denied.

When this happens, it is critically important to work with a law firm that has deep experience in amputee litigation. This experience plays a key role in helping law firms handle the tough, complex cases and negotiations that often arise because of coverage denials.