Can You Sue A Health Insurance Company For Negligence?

Insurance policies are designed to protect people in the event that they become injured or ill. However, you may be surprised to learn exactly how insurance policies work and the ways in which insurance companies take advantage of those who need them most.

Sadly, insurance company negligence is more common than you might think. Fortunately, with the help of a lawyer from our firm, you may be able to hold negligent health insurance companies accountable for their recklessness. You can contact our office for a free consultation today to find out what legal options are available to you.

Elements of Negligence

Insurance adjusters are required to adhere to specific rules and regulations under Maryland law. Some of these requirements include:

  • Notifying policyholders about policy availability troubles
  • Using reasonable care to obtain requested coverage options by policyholders
  • Considering the policyholder’s expressed coverage needs
  • Explaining the policy coverage options secured for policyholders

If your health insurance adjuster failed to adhere to these regulations, they may be held accountable when your claim is denied. For your lawsuit to be successful, your attorney will need to prove that the health insurance company or agent was negligent. To prove negligence, the following elements must be met as follows:

Duty of Care

For your insurance negligence lawsuit to be successful, your attorney will need to show that the health insurance adjuster or company owed you a duty of care. The insurance company might owe you a duty of care under the law.

An adjuster is required to use good judgment, conduct due diligence, and provide otherwise reasonable care to policyholders and claimants. If they fail to provide consumers with policies that adequately meet their needs, or if they handle claims in bad faith, the duty of care in question may have been breached.

Breach of Duty

After proving the health Insurance adjuster or company owed you a duty of care, your attorney must also show that there has been a breach of the duty of care.

A health insurance agent who fails to take reasonable care in handling a policyholder’s claim could be found in violation of their duty. Some examples of breaches of duty of care could include misleading a claimant about policy contents or omitting critical information.


The health insurance adjuster’s breach in their duty of care must be shown to have caused the victim’s damages. This means that had it not been for the actions of the insurance agent or company, the victim in question would not have endured the damages they did.

Your attorney may also consider whether proximate cause played a part in your damages, meaning the insurance company should have foreseen the damage their breach of duty could cause.


For your lawsuit to be successful, the defendant’s breach of the duty of care must have caused you to suffer considerable damages. This means your life must have been significantly affected in some way for you to be entitled to financial compensation.

This could include physical injuries, emotional trauma, or financial losses. As long as you have had to endure damages due to the negligent actions of your health insurance adjuster or company, they should be held accountable and compelled to compensate you accordingly.

Common Types of Health Insurance Company Negligence

Health insurance companies can act in bad faith or negligence more frequently than you might think. Although insurance adjusters are held to a higher standard, you may be surprised at how often insurance companies prioritize their own financial interests above doing the right thing.

Some of the more common ways in which insurance adjusters have been found negligent include:

  • Failing to notify policyholders of insurance company financial issues
  • Failure to sign policyholders up for requested coverage options
  • Failure to notify the insurance company of a policyholder’s claim
  • Misrepresenting the coverage included in a specific policy

If your insurance adjuster has not explained the details of the policy clearly, has not provided you with the information you need to make an informed decision regarding the insurance company’s coverage options, or denied your claim for coverage in bad faith, you might have the opportunity to pursue an insurance negligence claim against them.

Damages You Could Recoup In Your Lawsuit

In filing a lawsuit against your health insurance company or agent, you might be interested in wondering how much your claim is worth. Your attorney will need to carefully examine the details of your case and the ways in which your life has been affected by your injuries to determine how much you could be awarded in your claim.

However, you have the right to be made whole. You should be compensated for all of the ways your life has been affected by the insurance company’s negligence. Some of the more common damages you could recover in your lawsuit include:

  • Emotional distress
  • Inconvenience
  • Loss of income
  • Diminished earning capacity
  • Medical expenses
  • Loss of consortium
  • Loss of enjoyment of life
  • Loss of household services

These are just a few of the more common types of damages you could recover in your health insurance negligence claim. Find out how much you could be awarded when you contact a personal injury attorney in Maryland to discuss your damages in greater detail.

Get Help From a Maryland Personal Injury Attorney

If you are interested in learning more about how to proceed with your civil claim against a negligent health insurance company, but you do not know where to turn for help, reach out to our dedicated Maryland personal injury lawyers at Brown & Barron. Call for your no-cost, risk-free consultation today.

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