Maternity Benefits Misrepresented

UPDATED: Oct 1, 2022

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Maternity Benefits Misrepresented

I signed up for an insurance policy, through my employer that states maternity
benefits are covered under 100. Now the insurance is saying that just the pre-
natal visits are covered delivery and labs are not covered under the 100 percent
but are now subject to co-insurance and deductible. The plan details, in writing,
does not make any reference to these extra charges. Furthermore, if my
pregnancy is high risk- the 100 covered visits will not apply. Again, this is not
specified in insurance documentation. Will I be able to sue and recover via
Contingency fee lawyers? Thoughts.

Asked on March 28, 2019 under Insurance Law, New York


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

If the benefits were misrepresented to you, then yes, you could sue the insurer based on fraud (you'd sue the insurer since it is their disclosure materials, such as the written plan details, which misrepresented) and potentially recover compensation. But you are very unlikely to find any lawyer wiling to do this on contingency. You are most likely talking about a few thousand dollars in compensation: e.g. the value of the extra coverage you should have received, but did not. But most lawyers will not take contingency cases for less than several tens of thousands, or often over a hundred thousand, dollars of likely compensation. That is because with contingency cases, being paid is uncertain (winning a case is never guaranteed); and if you do get paid, it's typically not for many months or even a few years. Since on a contingency case, the lawyer invests work now--time he can't spend on other clients--in exchange for usually 25% - 35% of the recovery, few lawyers can afford to invest their time for a chance of getting a quarter or a third of a few thousand dollars a year or more later.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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