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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 Virginia, 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 Virginia 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, resulting in harm to an insured or enrollee, it could be held liable for damages. The determination of whether ordinary care was exercised is based on what is reasonable under the circumstances, and a breach of this standard could lead to a finding of negligence. Cases involving such issues would typically be resolved through the judicial system, where past court opinions and case law would guide the interpretation and application of these principles.

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Health care

negligence by health insurer

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Virginia State Code

Virginia State Code

Health care

negligence by health insurer

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