When Should Physicians Sue Insurers for Underpayment?

Although the decision to file a lawsuit against an insurer is never easy, there are certain situations in which taking an insurer to court over underpayment does make sense. For doctors, knowing when is the right time to file a lawsuit and how to best set themselves up for success in their case is extremely important.

A significant amount of underpayment suits filed by doctors result with them getting at least some (if not all) of their owed money through settlements. The biggest factor in determining whether or not to sue is how much money is at stake in the suit. The more money a doctor is owed, the more it makes sense to file a suit against the underpaying insurer.

However, it’s important that doctors understand the language included in their contracts about filing lawsuits against insurers. In some cases, doctors may have arbitration clauses that prevent them from being able to take action over payer disputes in the legal system. Usually, these clauses indicate that these types of disputes must go through an arbitration process instead, with the decision of the arbitrator being final.

If a doctor’s contract does allow him or her to sue, it is important that they do everything they can to build a strong case. Doctors should keep detailed notes about all of the money they are owed and records of when the insurer failed to pay the full amount of the bill or failed to make any payment at all. When doctors can prove that the underpayment or failure to pay is part of a larger trend rather than an isolated incident, they have a much stronger case in court and settlement proceedings.

To have the best chance of success in a lawsuit, doctors should consult with attorneys early in the process of building their case. Legal professionals are well versed in the regulations and various procedural aspects of reimbursement claims, which is an important asset to have in these claims.

Contact a knowledgeable New Jersey health care lawyer with Buttaci Leardi & Werner, LLC for more information about filing lawsuits against insurers for underpayment.

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Posted in: Dispute Resolution & Professional License Defense