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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 South Carolina, health insurance carriers, health maintenance organizations (HMOs), and other managed care entities are expected to adhere to a standard of ordinary care when making decisions about health care treatments. While South Carolina 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 in making treatment decisions, and that failure proximately causes harm to an insured or enrollee, the entity could be held liable for damages. The determination of whether the standard of care was breached and the causation of harm would typically be assessed on a case-by-case basis through the judicial system.

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Health care

negligence by health insurer

Individual & Family Legal Plan

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South-Carolina State Code

South-Carolina State Code

Health care

negligence by health insurer

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