In December of 2017, United Healthcare, the health insurance company, was sued by two amputees. The lawsuit alleges that the company violated its own policies by refusing requests for some prosthetic devices without an investigation into the requested device. The amputees are asking that the lawsuit be certified as a class action and that the company be forced to change its policies going forward.
According to the terms of the insurance contract, “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 for the member’s needs.” The lawsuit alleges that United uses this provision to systematically deny prosthetic arm and leg devices without assessing or determining the member’s functional needs, without properly assessing or determining how the requested prosthetic device meets the minimum specifications of the member’s needs, and without identifying an alternative prosthetic device that does meet the minimum specifications of the member’s needs.
Both plaintiffs in the lawsuit requested an artificial limb that was powered by microprocessors. Both plaintiffs were active and needed a device beyond a basic limb. In both cases, the insurance company denied the request without any reasoning or evaluation of the situation.
The plaintiffs are asking that United reimburse them for their prosthetic limbs, and that going forward the company be required to change its policies about coverage for artificial limbs. If you are suffering from limb loss, and your insurance company has denied your request for an artificial limb, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation on your case.