Can I sue my dental insurance for not paying what they owe?

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Can I sue my dental insurance for not paying what they owe?

My fiance has been to the dentist twice in the past year. The dentist as well as my fiance have called the insurance company several times and they say every time that they will process their payment within the week. It has almost been a year since the first dentist visit and they still haven’t paid what they owe. My fiance has also contacted the person in charge of benefits for his employer and he said he would

handle it, but my fiance hasn’t heard from him even.after e-mailing him asking for the status.

Asked on April 12, 2016 under Insurance Law, Pennsylvania

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

Yes, a person may sue their insurer for breach of contract (that's what an insurance policy fundamentally is: a contract) for not paying benefits when, under the terms of the contract and the facts/ circumstances, they should have paid. To win, the person needs to show that under the facts as they existed and the plain terms of the policy, payment was required.


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