Brooklyn, NY asked in Health Care Law and Insurance Bad Faith for New York

Q: I was denied an MRI from Emblem health several times. New insurance now diagnosed with arthritis can I sue Emblem?

Emblem was my former insurance through my former employer. I suffer from hip pain. I was approved for an X-ray of my hip which showed normal. However the pain was severe. My PCP requested an MRI on my behalf several times, but Emblem denied the request each time. My coverage ended with Emblem on 8/13/21. I have new insurance now and I was approved for an MRI done in 7/522 which I was diagnosed with osteoarthritis of the same hip. If Emblem would’ve approved the MRI initially, I would’ve been diagnosed sooner. Now the pain is unbearable but I am in physical therapy. Is this a case of negligence in Emblems behalf?

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

A: I'm sorry for your ordeal. You ask if you could sue. I think it would be difficult to find a law firm to handle such a matter on a contingency basis. MRIs are often initially denied as a knee-jerk reaction in many instances. They are big-ticket items compared to other less-sophisticated diagnostic imaging methods. Many insurance carriers tend to be conservative in approving them, some more so than others. The carrier could have supporting opinions as to why it was their best judgment that the MRIs were not medically necessary at the time. This is only my individual opinion. You could reach out to law firms to get their perspective on things. It's possible other attorneys could see things differently. Good luck

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