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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 New Jersey, health insurance carriers, health maintenance organizations (HMOs), and other managed care entities are expected to adhere to a standard of ordinary care when making health care treatment decisions. If they fail to exercise this level of care, they can be held liable for any harm caused to an insured or enrollee as a result. This liability can arise from specific New Jersey statutes or from the state's common law under a negligence theory. The negligence theory would require demonstrating that the managed care entity breached a standard of care that was owed to the patient, that the breach was the proximate cause of harm, and that damages resulted from this harm. It's important to note that the specifics of any case would depend on the actual facts and the application of New Jersey law as interpreted by the courts.

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Health care

negligence by health insurer

Individual & Family Legal Plan

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New-Jersey State Code

New-Jersey State Code

Health care

negligence by health insurer

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