Sifting through the coverage details of an insurance policy can be an intimidating experience for the average consumer or business owner. Policies are usually divided into four sections: COVERAGE, EXCLUSIONS, DEFINITIONS, and CONDITIONS. For example, the coverage included in your health plan can affect many things – who will care for you, the type of care you will receive, where you can go to receive care, when you can receive care, and how much you will pay for your care.

Many individuals receive their major medical insurance through an employee benefit plan. Approximately 7 out of every 10 Americans are subscribers to a Health Maintenance Organization (HMO). As an HMO subscriber, your rights to certain benefits and your ability to pursue a legal action against an HMO for the negligence of one of its care providers may be governed by the federal law known as the Employee Retirement Income Security Act of 1974. ("ERISA"). Further complicating the issue, many federal and state courts are split on the validity of the provision of ERISA prohibiting negligence or professional malpractice claims against managed care insurers under state law.

The issue of your insurance coverage is an important one. Whether you’re purchasing insurance coverage for yourself, your family, or your employees, it’s important that you completely understand your coverage and its limitations. Kightlinger & Gray has been working with insurers, businesses and individuals since 1946, and has established a reputation as one of the nation’s leading insurance litigation firms.