A California man has sued United Healthcare on behalf of himself and other individuals suffering from limb loss, for its failure to provide him with the proper artificial limb. He claims that United improperly failed to assess his needs or provide any reasons for denying him with the leg.
The man suffered severe injuries in an accident in 2017. As a result, he had a below-the-knee amputation of his left leg. At the time of the accident, he had insurance through United due to a policy issued to his wife’s employer. He maintained an active lifestyle that included jogging, hiking, and mountain biking. He was in his 20s.
His doctor referred him to a prosthetist for a below-the-knee prosthesis. Because of his active lifestyle, the prosthetist recommended that he be outfitted with a below-the-knee device that included a trans-tibial high-fidelity interface.
United Healthcare denied the request for his device because it “may not be the most basic leg” that meets his needs. United says that his health plan only covers the most basic artificial leg that meets his needs. The man appealed twice, but the company denied his appeal.
His lawsuit claims that United acted wrongfully and did not properly assess or determine his functional needs, the minimum specifications for his functional needs, whether his prosthetist was wrong about his needs and the minimum specifications for his needs, and what alternative prosthesis met his needs. The lawsuit also claims that United failed to provide any facts or reasons supporting his denials and instead simply claimed that the requested device was not the most basic for him.
If you are an amputee and you have had your claim for a prosthesis denied by an insurance company, you should speak with an attorney. Call me, Conal Doyle, amputation attorney, at 310-385-0567. I am currently working on several lawsuits against health insurance companies which you may be eligible to join. Call today to learn more.