Apr 22, 2019

Delayed Claim for Prosthetic Leg

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Brian S. King
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Hiran Ratnayake with the The News Journal in Delaware reports on a two year delay in payment of a prosthetic leg for Stephen Fine, an insured of Horizon Blue Cross Blue Shield of New Jersey.  You can read the story here.  In the process of writing the story, Hiran contacted me for information about the relationship between ERISA and state insurance law.  

It makes your blood boil to read about the facts surrounding Mr. Fine's experience with Horizon.  The lack of any meaningful remedy under ERISA for insureds such as Stephen absolutely guarantees that insurer foot dragging will proliferate.  

Thanks to Hiran for his good work.  It's pretty clear that his reporting is going to result in Stephen's claim getting paid. Would Horizon have paid this claim without this type of publicity or a lawsuit?  Who knows.  In the war of attrition between insurers and insureds, the Horizon's of the world definitely have more ammunition.  

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