ABA Family Legal Guide

Health-Care Law

Health-Care Options

Health Insurance and Managed Care Organizations

Can I sue my managed care organization for malpractice?

A federal appeals court has ruled that MCOs and their medical directors can be sued for medical malpractice when they make a decision about the treatment of a patient that causes the patient harm. This applies to individual decisions, not to overall corporate policies. This means that consumers can sue an MCO for injuries resulting from the company's refusal to authorize medically necessary treatment.