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HMO Contract

Florida HMO Liability Attorney

Can you sue your HMO (Health Maintenance Organization)? Maybe, but you’re going to need help.

HMOs are considered to be an employee benefit plan that falls under the FEDERAL Employment Retirement Income Security Act of 1974 (ERISA) and for that reason, many courts have made it difficult to sue HMO’s for negligence or malpractice because state law doesn’t apply to these plans. Put simply, your only option might be to file a suit in your state’s court system against the physician, but not the HMO. It just depends on the state.

This sounds complicated because it is. Some states hold HMO’s & their employees responsible for patient harm when they have failed to provide basic care or make timely treatment decisions. Some states do not. Some states prohibit HMO’s from dropping physicians from their contracts because they sided with a patient. Some states allow those physicians to be removed from the list of participating doctors and panels.

But, you may have a case if you can prove that your HMO:

  • Denied or delayed medical care, tests or other treatments
  • The denial or delay caused further injury or illness

There is a short timeframe to bring a lawsuit against an HMO and once that deadline passes, you will have no course of action against the HMO. We can help you determine how to appeal a denial by your HMO and if you live in a state where you can sue your HMO for denial of treatment and if not what your other options are.