Many people who require medical tests or procedures use insurance to pay for the services they receive. While insurance companies often conduct reviews to determine if care is necessary, they do not provide medical care. Thus, as discussed in a recent opinion issued in a New York case, they generally cannot be held liable for medical malpractice. If you suffered harm due to negligently rendered medical care, it is in your best interest to consult a Syracuse medical malpractice lawyer about your potential claims.
The Plaintiff’s Harm
Allegedly, the plaintiff visited her doctor in November 2018 with complaints of pain in her right hip. She underwent physical therapy for several weeks, but her symptoms did not improve. Her doctor then referred her to an orthopedic surgeon, who ordered an MRI. The surgeon sought pre-authorization for the MRI from the defendant, the plaintiff’s insurance provider. The defendant denied the request for pre-authorization after a doctor reviewing the plaintiff’s request, and health history determined that she failed to show that the MRI was medically necessary.
Reportedly, the defendant elaborated that the plaintiff had not demonstrated that she failed to improve following a six-week regimen of rest, physical therapy, and medication, despite that she had completed the course of physical therapy and pain medication recommended by her doctor. The doctor appealed, and after several weeks the MRI was approved. The plaintiff underwent an MRI, which revealed cancer in her right hip. Her leg was amputated, and her treating doctor advised if she presented a month earlier, her leg could have been saved. She then filed a lawsuit against the defendant asserting numerous claims, including medical malpractice. The defendant moved for dismissal.
Medical Malpractice Claims Under New York Law
In cases in which the duty a defendant owes to a plaintiff arises from a patient-physician relationship, a breach of the duty will give rise to a claim sounding in medical malpractice rather than ordinary negligence. A medical malpractice claim must be based on conduct that is considered medical treatment or bears a substantial relationship to the rendering of such treatment.
In the context of a physical exam performed for the purpose of offering an evaluation to a third party, like an insurer, an implied patient-physician relationship may rise if the physician treats the party examined or offers recommendations regarding a course of treatment. In the subject case, the court found that plaintiff’s medical malpractice claim failed due to the fact that there was no patient-physician relationship between her and the defendant. While there was a medical aspect to the review, it did not give rise to a patient-doctor relationship. Thus, the court dismissed her claim.
Speak to a Seasoned Syracuse Lawyer
When a health care provider fails to abide by the applicable standard of care, it may cause errors that lead to irreparable harm. If you suffered injuries due to medical malpractice, you might be owed damages, and you should speak to a lawyer as soon as possible. At DeFrancisco & Falgiatano Personal Injury Lawyers, our seasoned attorneys are dedicated to helping people seek compensation for losses caused by careless doctors, and if you hire us, we will work tirelessly on your behalf. You can reach us via our form online or at 833-247-8427 to set up a meeting.