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Health care

negligence by health insurer

Laws vary from state to state, but in some states a health insurance carrier, health maintenance organization, or other managed care entity for a health care plan has the duty to exercise ordinary care when making health care treatment decisions and is liable for damages for harm to an insured or enrollee proximately caused by its failure to exercise such ordinary care.

This liability may be created by a specific state statute or by the state's common law (court opinions or case law) under a negligence theory for breach of the standard of care (reasonableness).

In Montana, health insurance carriers, health maintenance organizations, and other managed care entities are expected to adhere to a standard of ordinary care when making health care treatment decisions. While Montana does not have a specific statute that explicitly imposes this duty, the principle is generally derived from common law under negligence theories. This means that if such an entity fails to exercise ordinary care, and that failure proximately causes harm to an insured or enrollee, the entity could be held liable for damages. The determination of whether ordinary care was exercised would typically be assessed based on what is reasonable under the circumstances, considering the practices and standards of the medical and insurance community. Plaintiffs would need to demonstrate that the managed care entity breached its duty of care and that this breach was the direct cause of the harm suffered.

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Health care

negligence by health insurer

Individual & Family Legal Plan

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Montana State Code

Montana State Code

Health care

negligence by health insurer

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