Two individuals who are suffering from limb loss sued United Healthcare in California, claiming that the company wrongfully denied their claims for prosthetic limbs without properly investigating their situation. They are asking the court to certify the lawsuit as a class action so that other individuals whose claims for prostheses have been wrongfully denied by United can join in on the lawsuit.
United Healthcare has written guidelines that it uses to implement its insurance policies. One of those guidelines is called “Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs”. That guideline states that “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”.
The lawsuit alleges that United Healthcare has used its written policy to systematically deny claims for prosthetic arm and leg devices without assessing the individual’s functional needs, without assessing if the requested device meets the minimum specifications of the individual’s needs, and without identifying an alternative device that does meet the minimum specifications of the individual’s needs. Instead, the lawsuit alleges that the company simply issues a denial when certain prosthetic devices are requested.
If you are suffering from limb loss and you are covered by an insurance policy, and the insurance company has refused to pay for a prosthetic limb that you requested, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am currently working on several lawsuits against insurance companies and I can help. Call today to learn more or to schedule a free consultation.