A few days ago a court dismissed a case brought to obtain payment of a denied medical claim. That is not really very unusual. The deck is stacked against health care providers and patients who want to sue for denied medical benefits, especially when those claims involve ERISA. But as I read the Judge’s opinion today, I was really quite amazed at the poor legal representation on behalf of the plaintiffs.

First, the case was brought by two hospitals operated by a large, reputable healthcare system.  They have the sophistication to recognize that they need to hire experienced, knowledgable legal counsel. Second, the denied claims were no small matter; they totaled several hundred thousand dollars, a powerful incentive to hire competent legal counsel.  Despite these facts, the Judge's opinion made clear that the hospitals' attorney was clearly out of his element.  As a result of several significant blunders in how the case was presented and the failure to lay the proper foundation before litigation even started, the case was dismissed; the hospital received nothing.

But here’s the kicker: I looked up the website of the attorney representing the hospital and found that he claimed to specialize in litigating denied medical claims! A quick search of cases in his jurisdiction, however, revealed no other reported cases involving denied medical claims in which he was involved.

I won’t disclose the hospital’s or attorney’s name. But no healthcare provider or patient should let this happen to them. Evaluating, appealing and litigating denied health insurance, managed care or disability claims is as challenging an area of law as any. It is many steps beyond collections work.  The confluence of medical, insurance and legal issues is something that few people really understand.

When you need the resources to handle an important claim in this area, don’t mess around with someone who can’t demonstrate that they know what they are doing and have done it before. Trusting this type of work to a neophyte or amateur increases the likelihood that you are simply throwing your money away.

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