Published January 13, 2015
PATIENTS' RIGHTS – All Americans with private or public health insurance are guaranteed access to emergency care and medical specialists, including gynecologists and pediatricians, needed medicines and care during clinical trials.
FEDERAL COURTS – Most patients can sue in federal court over benefits, including disputes about contracts, co-payments and other nonmedical judgments.
STATE COURTS – Patients can sue insurers in state courts over coverage denials if based on medical judgment.
CLASS ACTION LAWSUITS – Class-action lawsuits restricted to employees of one company and one health care plan. Employees of different companies could not join together in a suit.
DAMAGES LIMITS – In state courts, no limits for wages and other economic losses, pain and suffering or punitive damages – unless a state's law imposes them. In federal courts, no limits for wages, pain and suffering and other losses; a $5 million limit on punitive damages.
INDEPENDENT REVIEWS OF PLAN DECISIONS – Patients are generally required to exhaust outside appeals before suing. In special circumstances, lawsuits would be allowed during the appeals process.
EMPLOYERS – Most employers shielded from lawsuits unless they directly helped make a decision against a patient. Only companies that offer self-insured and self-administered insurance plans would be exposed to legal liability, and even they could protect themselves if they found an outside entity to assume the risk.