Middle Island, NY asked in Insurance Bad Faith and Insurance Defense for New York

Q: Insurance company denied medically necessary breast reduction. My back is now more damaged. Can I sue?


I have a very large chest and as such I also suffer from crippling back pain. It has gotten to the point I can no longer function normally and cannot even get out of bed some days due to sciatica. I tried to get my insurance company to pay for a breast reduction and they denied me. In this time while I was waiting for them to pay and was denied my back got even worse and there is evidence of this through scans. Is it possible to sue them since they refused to pay for something that is medically necessary and should be covered and their denial of this surgery caused my back to get even worse. Do I have a case?


1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY
  • Licensed in New York

A: I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law firm would handle your case on a contingency basis (no win - no fee), not an arrangement where you pursue the matter paying a law firm on an hourly basis.

There are questions that a law firm would need to sort out. What are the provisions of your insurance policy? Are remedies for appeal or arbitration outlined? What is your medical history? Did you explore having an orthopedic surgeon or other medical professional help prepare a response to the insurance carrier's denial arguing for the medical necessity of surgery? The answers to some of these questions could require opinions from orthopedic surgeons, radiologists, or other medical specialists.

To get a meaningful answer to your question, you could reach out to law firms to discuss in further detail. Good luck

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.