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Suit Claims Insurance Company Canceled Policy After Woman's Costly Surgery

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Brent Adams
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A man from Madison County, Illinois has filed suit against his former insurance provider, claiming that the company canceled his insurance after his wife underwent a costly surgical procedure.


According to Dale Warner, he was insured by Group Health Plan, Inc., a Coventry Health Care Plan, when his wife, who was also insured through his plan, sought pre-certification for a medical procedure she intended to have performed in August 2008.


According to the complaint Werner filed on August 19 in Madison County Circuit Court, he called Group Health Plan in July 2008, at the same time his wife was seeking pre-certification, to inquire about his premium payment.


The suit claims that Group Health Plan approved Werner’s wife’s pre-certification and informed him that he had no premium due and, in fact, had a credit balance in his favor.


The suit says Werner’s wife then underwent the costly procedure, based upon said reliance.


However, after Werner’s wife underwent the procedure, Group Health Plan canceled his insurance on the basis of his alleged non-payment of which he was unaware. The company refused to reinstate the policy and refused to pay the remaining medical claims for the surgery.


The suit says Group Health Plan also asked Warner to pay for bills it had already paid following the surgery.


Werner claims that due to Group Health Plan’s actions, his credit scoring has been degraded, which could affect his future ability to obtain credit, and he incurred costs and expenses related to missed days from work, telephone calls, and legal costs.


Werner seeks damages in excess of $300,000, plus costs, from the seven-count suit.

Category: Insurance Disputes

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