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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 Utah, 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. If they fail to exercise this level of care, they can be held liable for any harm that results to an insured person or enrollee. This liability can arise from specific Utah statutes or from common law principles of negligence, which require entities to act reasonably and avoid causing harm. Utah courts would assess whether the managed care entity breached the standard of care and whether this breach was the proximate cause of the harm suffered by the insured or enrollee. It is important to consult with an attorney to understand the specific applications of these laws and how they might apply in a particular case.

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Health care

negligence by health insurer

Individual & Family Legal Plan

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Utah State Code

Utah State Code

Health care

negligence by health insurer

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