Can You Really Sue Your Insurance Company? A Detailed FAQ Guide

When can a denied insurance claim become grounds for a lawsuit?

Before you can sue your insurance company, you must go through all the necessary appeals. This appeals process is required in healthcare, even though you wouldn’t face these kinds of hurdles in many other areas. Only once you’ve fully exhausted the appeals — meaning you’ve done everything you can to resolve the issue directly — should you consider taking legal action.

At that point, an attorney will step in. They’ll review all the appeals, paperwork, and communications between you and the insurance company to understand why the claim was denied. This can apply to anything from surgeries and hospital visits to medications or cancer treatments. Once the lawyer confirms there’s a strong legal argument under your policy and relevant laws, you can move forward by formally engaging the lawyer, agreeing on payment terms (like contingency or hourly), and allowing them to draft and file a legal complaint with the court.

What happens after the complaint is filed?

Once the complaint is ready, it’s filed with the court along with other essential documents, like a summons that notifies the insurance company they must respond. Behind the scenes, the legal team carefully organizes all the medical records, bills, and details about what’s at stake. After you, as the patient, decide to move forward, most of the process is handled by the legal team — you won’t be heavily involved day-to-day. From there, the case enters the litigation process, where your attorney works to fight for the healthcare you need.

What about situations where a patient can’t afford lifesaving treatment?

Many medications and treatments, especially for conditions like cancer, can cost tens of thousands of dollars per month — far beyond what most people can afford. In urgent cases, there often isn’t time to wait through a normal appeals process.

For example, when a terminal cancer patient is denied essential treatment, an attorney may file an emergency injunction alongside the complaint. This asks the court for an immediate emergency hearing, bypassing the usual wait time to prevent life-threatening delays. These triage-type cases require swift legal action to give the patient a fighting chance.

Can you sue an insurance company for bad faith or misconduct?

Yes — but it’s tricky, especially in states like Florida. Bad faith lawsuits arise when an insurance company’s behavior is negligent, deceptive, or intentionally harmful, going beyond just denying coverage. Florida statutes outline specific reasons an insurer can be held liable for bad faith, and if proven, the patient can seek additional damages beyond the cost of treatment.

However, insurers are given a “right to cure” — meaning they have 60 days to fix the issue before you can sue for bad faith. If they correct the problem within that window, you may not be able to pursue bad faith damages, though you can still sue over the original denial.

Is suing an insurance company different from other types of lawsuits?

It depends on the type of claim. A breach of contract claim (arguing the insurer failed to uphold the policy terms) is handled like most other contract lawsuits. But if you’re suing under federal laws — for example, under ERISA (for employer-provided plans) or under Section 1557 of the Affordable Care Act (which prohibits discrimination by insurers) — the legal framework is much more specialized. Medicaid and Medicare cases also follow different rules, often requiring administrative hearings rather than direct court action.

How long does it take to resolve a lawsuit against an insurance company?

The timeline varies widely, depending on whether the insurance company wants to settle or fight. A case can wrap up in as little as three months or drag on for two years or more. Unfortunately, insurance companies often fight even when it costs them far more in legal fees than simply approving the treatment or claim.

For example, one patient needing back surgery had to endure almost three years of litigation, even though the surgery was clearly necessary. Despite the patient’s daily pain, the insurance company continued to fight, showing little compassion or urgency. This reflects a broader industry pattern where insurers sometimes prefer to drag cases out, betting that the legal pressure will wear down patients or their attorneys.

Do most lawsuits against insurance companies go to trial or settle?

Statistically, about 90% of cases settle before reaching trial. However, the time it takes to get to a settlement can be long, largely because insurers deliberately delay through legal tactics. They may hope to exhaust the plaintiff or the attorney into giving up.

Some insurance companies may even recognize specific attorneys or firms — for instance, attorney Maria Santi has seen cases where opposing counsel bombards her with motions just to slow things down. Still, determined legal teams push forward, sometimes all the way to appeals and higher courts, in an effort to create stronger legal precedents in this still-developing area of law.

What kinds of legal tactics cause delays in these cases?

Delays often stem from procedural moves like filing motions to dismiss, which can take months just to get a hearing with a judge. Even when these motions are denied (as they often are, since everyone has a legal right to sue), they add time. Other common tactics include motions to strike parts of the lawsuit, lengthy discovery processes, taking and postponing depositions, and taking advantage of overburdened court systems where judges aren’t always available quickly.

Emergencies or scheduling conflicts on either side can add further delays, but the most common reason cases stretch out is a deliberate strategy to slow things down.

Do most people even realize they can sue their health insurance company?

Surprisingly, many don’t. While most people know they can sue over things like car accidents or property damage, far fewer understand that they can sue a health insurance company over denied medical claims. Part of this may come from how the healthcare system operates — people often accept a doctor’s word without question, and they may treat the insurer as just another authority to obey.

However, patients have rights, including the right to challenge and legally contest insurance decisions. Educating people about these rights is critical, especially in a field where the laws are still evolving and many legal arguments fall into gray areas.

If you need legal help or want to connect with Maria T. Santi and her team, visit healthandmedicinelawfirm.com. And if you found this guide helpful, don’t forget to subscribe to the From the Clinic to the Courtroom: Health Law Unpacked podcast and leave a review!

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