Can doctors who work for health insurance companies be sued for malpractice?

[victorio83]

Health insurers have doctors who review things like requests for prior authorizations. If a doctor who never examines you in person and doesn't know your medical history overrides your own doctor's medication or treatment requests, isn't that malpractice? My own doctor could certainly be sued for writing prescriptions without ever examining me.

[gillivray5]

Oh boy, I know where you are coming from. A good part of my day is spent arguing with insurance companies over tests a doctor feels are necessary to best diagnose and treat.

There is precedent where insurance companies have been sued over this very issue. Suing the company doctor for malpractice probably wouldn't work as he/she is working as an agent for the insurance company and they assume the liability. Check with the insurance commissioner in your state. It will depend on whether your plan is privately administered or under ERISA laws.

[rumford]

Only if it could be proven that the denial was directly related to your death, etc. Even then it would be unlikely you could win, you agreed when accepting the insurance to abide by their rules.

[ashbey15]

any doctor can be sued! just remember that documents do the talking here, so keep all your papers and reciepts and any thing showing what procedures you were submitted to. keep well organized records for your attorney, he`ll love you for it and shows that you are responcible and not just looking to get or steal some money