Can you sue your HMO?

The answer is “yes”, but suing your HMO is more difficult than suing a doctor or a hospital.  

HMO liability means holding an HMO or managed care organization responsible for failing to provide a patient with adequate health care. This failure resulted in injury or even death to the patient in question. 

HMO’s such as Kaiser Permanente, U.S. Healthcare, Prudential, and other organizations may be liable for a patient’s injury or death. However, the malpractice process in these types of cases is predicated by laws that vary from state to state. Some states hold HMOs to be liable when they commit malpractice, but others limit what type of compensation you can sue for if your health insurance comes through your employer, such as pain and suffering or punitive damages.

The Kaiser Permanente organization, for example, has a mandatory arbitration clause within most of their HMO contracts that prohibits medical malpractice claims to be brought against them. Instead, a patient must first go through a mandatory arbitration process which is a kind of private legal procedure that doesn’t go through the judicial system and is not governed by any court. Therefore, the laws of a particular state governing HMO liability don’t apply. Rather, the contract between Kaiser and its patients control the process.

The purpose of the arbitration process is to reach an out-of-court settlement for medical malpractice claims. Hearings are overseen by a neutral attorney, retired judge, or panel. Evidence is heard from both sides, and then a legal judgement is handed down which is based upon that evidence.

Reasons people sue their HMO

There are a variety of reasons that can result in an HMO liability case including:

  • Delaying tests
  • Denying tests
  • Delays in treatment
  • Treatment denial
  • Not getting referred to a specialist

If you’re considering suing your HMO for medical malpractice, it’s crucial to the success of your case that you hire a medical malpractice attorney that is experienced in handling Kaiser Permanente Arbitration hearings.

Do you have a malpractice case?

While it’s true that you can sue your HMO for malpractice, many HMOs or managed care organizations have made it very difficult by imposing certain limitations on their members when it comes to filing malpractice lawsuits.

You need the services of an attorney who understands the various complexities involved in these types of cases.  Scott S. Harris, medical malpractice attorney in San Diego, is very familiar with the Kaiser Arbitration process and knows how to sue Kaiser Permanente to get results for his clients.

Contact the Law Offices of Scott S. Harris about your Kaiser Arbitration case or other medical malpractice case you may have with your HMO.