I want to know if I can bring a lawsuit against a private insurance company

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I want to know if I can bring a lawsuit against a private insurance company

I was involved in an 18 wheeler accident and have been on benefits from a private insurance company since. I have recently had surgery and am starting therapy. The insurance company has in formed me that my benefits are fixing to expire. I am in no way ready to go back to work and still have issues they didn’t address.

Asked on June 19, 2017 under Insurance Law, Texas

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 6 years ago | Contributor

What are you suing them for? An insurance policy is a contract: an insurer needs to pay you those amounts or benefits--and ONLY those amounts or benefits--called for in the policy/contract. So if they are violating the terms of the contract/policy, in that you are owed more or longer-duration benefits under it, then if they cut them off prematurely, you could sue them based on breach of contract to get the benefits you should recieve.
But if under the policy's terms, your benefits are expiring--they have paid out for as many visits, or as much money, or for as long a period of time, as they are required--then they can cut off your benefits once they exceed what you are entitled to under the policy. They do not need to pay even $1 more or for even one more doctor/therapist/clinic visit that the policy requires, and your need for more benefits doesn't matter: all that matter is what the policy says.


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