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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 Oklahoma, 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 and their actions proximately cause harm to an insured or enrollee, they can be held liable for damages. This liability can arise from specific state statutes or under Oklahoma's common law, particularly under negligence theories that assess whether the managed care entity breached the reasonable standard of care expected in the industry. While Oklahoma may not have a statute explicitly addressing this duty for managed care entities, case law developed through court decisions provides guidance on the standard of care and the potential for liability in instances of negligence.

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Health care

negligence by health insurer

Individual & Family Legal Plan

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Oklahoma State Code

Oklahoma State Code

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Health care

negligence by health insurer