Your University’s or College’s Health Insurer Denied Your Medical Claim. You Have Rights.

You paid for health insurance through your university, college, or school. You got seriously sick or hurt. Then the insurance company said no — often without a valid medical reason. That may be insurance bad faith — and it may be illegal. Berger Montague is interested in investigating your potential case.

What is Student Health Insurance Bad Faith?

Student health insurance bad faith occurs when a health insurer contracted by a university or college arbitrarily denies or limits a valid medical claim — without a legitimate contractual or medical basis. Because student health insurance is paid for by students, not employers, it is generally not subject to ERISA, which means that students have access to powerful state law remedies, including punitive damages, that are available in certain states. Contact us: (800) 424-6690  |  info@bm.net  |  bergermontague.com

About the Investigation

Investigation Alert – When University Health Insurers Deny or Improperly Limit Students’ Legitimate Medical Claims

Berger Montague is investigating claims on behalf of university and college students across the country who purchased health insurance through their school, and subsequently had a legitimate medical claim that was wrongfully denied, improperly limited, or arbitrarily reduced by the insurance company — without a sound medical or contractual basis.

Large universities often offer student health insurance plans to enrolled students and, in many cases, their dependents. These plans are typically purchased directly by the student or their parents, and are administered through a private health insurer selected by the school. When these insurers act in bad faith — denying valid claims, misrepresenting policy terms, or deliberately delaying payment — students and their families suffer real and lasting harm.

Because student health insurance premiums are paid by students rather than by employers, these plans are generally not governed by federal ERISA law. This means the full range of state bad faith insurance remedies may be available to you.

ERISA Does Not Apply to Most Student Health Plans

Because student health insurance is paid for by students, not employers, it is typically exempt from ERISA. Under state bad faith laws, depending on the state, you may be able to recover:

• The full amount of wrongfully denied benefits
• Interest on amounts owed from the date of denial
• Consequential damages (unpaid medical bills, credit damage, alternative care costs)
• Emotional distress damages
• Punitive damages for egregious insurer conduct
• Attorneys’ fees and litigation costs

What We’re Investigating

Types of Claims That May Have Been Wrongfully Denied

Berger Montague is particularly interested in speaking with students who had a serious medical claim improperly denied or limited. The most common categories include:

• Cancer diagnosis & treatment denied as “not medically necessary”
• Other diagnosis & treatment denied as “not medically necessary”
• Emergency room treatment and hospitalization following accident or illness
• Surgery denials — recommended procedures refused coverage
• Mental health & psychiatric hospitalization claims improperly denied or limited
• Substance use disorder treatment — inpatient rehab denials
• Serious infectious disease requiring extended care or specialist referral
• Physical therapy & rehabilitation following serious injury
• Maternity and reproductive health care claims improperly denied or limited
• Any serious medical claim denied without a legitimate contractual or medical basis

What Bad Faith Looks Like

How Insurers Improperly Deny Student Health Claims

Not every claim denial is bad faith — insurers can legitimately deny claims that are outside policy coverage. But there is a critical legal difference between a legitimate denial and conduct that is arbitrary, unreasonable, or deliberately designed to avoid payment. Bad faith denials typically share one or more of these warning signs:

1.  Denial of a Clearly Covered Claim

The insurer denies a medical service that is expressly covered by the policy, without a legitimate medical or contractual reason.

2.  Fabricated “Not Medically Necessary” or “Pre-Existing Condition” Determinations

The insurer manufactures a reason to deny coverage — often without ever examining the patient — using jargon-heavy language designed to confuse and deter appeals.

3.  Denial Without a Proper Investigation

The insurer denies a claim without conducting any meaningful review of the facts, the medical records, or the applicable coverage — relying instead on an internal reviewer who never examined the patient.

4.  Unreasonable Delay Tactics

The insurer sits on a claim for weeks or months, asking for repeated documentation, hoping the student will give up or that medical providers will send the bill to collections before the insurer is forced to pay.

5.  Misrepresentation of Policy Terms

The insurer tells a student or their family that a claim is not covered when, in fact, it is — relying on confusing language or deliberately misleading explanations to avoid payment.

6.  Partial Payment Designed to Pressure Settlement

The insurer pays a fraction of what is owed, offering an artificially low amount while pressuring the student to accept it as “full and final” payment.

Real-World Impact

The Consequences of a Bad Faith Denial Can Be Devastating

When a university student has a legitimate health insurance claim denied, the consequences extend far beyond one unpaid medical bill. Students who have had claims improperly denied or limited report:

• Inability to afford necessary follow-up care, leading to worsening medical conditions because treatment was delayed or foregone
• Thousands of dollars in unexpected out-of-pocket medical expenses that should have been covered
• Medical debt sent to collections, damaging credit scores at a critical stage of life and career
• Forced withdrawal from school to deal with financial and health consequences that could have been avoided
• Severe emotional distress, anxiety, and depression arising from the denial and its financial aftermath
• Family financial hardship, particularly where parents co-signed loans or paid premiums expecting coverage to be honored

When these harms are caused by an insurer’s bad faith — meaning its deliberate or reckless choice to place its own financial interests above its contractual obligations — state law provides meaningful remedies.

Your Legal Rights by State

State Bad Faith Insurance Laws — What You May Be Entitled to Recover

Virtually every state recognizes some form of legal claim against an insurance company for bad faith denial or mishandling of a legitimate insurance claim. The table below summarizes the bad faith landscape in key states with significant protections for policyholders. This is not an exhaustive list — if your state is not listed, contact us for a free evaluation.

State	Legal Basis	Potential Remedies	Statute Reference
California	Common law tort + Unfair Insurance Practices Act + UCL	Punitive, Consequential, Emotional Distress, Atty Fees	Cal. Ins. Code §§ 790–790.10; Bus. & Prof. Code § 17200
Pennsylvania	Statutory bad faith	Punitive, Interest, Atty Fees & Costs	42 Pa. C.S. § 8371
Florida	Statutory first-party bad faith + common law	Excess Damages, Punitive, Atty Fees & Costs	Fla. Stat. § 624.155; Fla. Stat. § 627.428
Texas	Texas Insurance Code — unfair settlement practices	Treble Damages, Actual Damages, Atty Fees	Tex. Ins. Code Ch. 541; Bus. & Com. Code § 17.50
Washington	Insurance Fair Conduct Act + CPA	Actual Damages, Treble (CPA), Atty Fees & Costs	RCW 48.30.015; RCW 19.86
Massachusetts	Consumer Protection Act applies to insurers	Double or Treble, Atty Fees	G.L. c. 93A; G.L. c. 176D
Colorado	Statutory first-party bad faith	2× Covered Benefit, Atty Fees & Costs	C.R.S. § 10-3-1116
Wisconsin	Common law + direct action statute	Punitive, Consequential, Emotional Distress	Wis. Stat. § 628.46
Nevada	Statutory private right of action	Actual Damages	NRS § 686A.310
Oregon	Insurance Code + UTPA	Actual Damages	ORS § 746.230
Georgia	Statutory bad faith penalty	50% Penalty, Atty Fees	O.C.G.A. § 33-4-6
New York	Common law + GBL § 349	Treble (GBL), Actual Damages, Atty Fees (GBL)	GBL § 349
New Jersey	Common law	Actual Damages	Common law
Illinois	Insurance Code § 155 — unreasonable & vexatious conduct	Atty Fees & Costs, an amount not to exceed any of the following amounts: (a) 60% of actual damages; (b) $60,000; or (c) the excess of the amount which the court or jury finds the insured is entitled to recover	215 ILCS 5/155
Minnesota	Statutory first-party bad faith	½ Excess Award (up to $250K), Atty Fees	Minn. Stat. § 604.18
North Carolina	Unfair & Deceptive Practices Act	Treble Damages, Atty Fees	G.S. § 75-1.1; § 58-63-15
Virginia	Bad faith refusal to pay + UDAP	Double Damages, Atty Fees	Va. Code § 38.2-209; § 38.2-510
Arizona	Common law tort	Punitive, Consequential, Emotional Distress	ARS § 20-443
Indiana	Common law bad faith + DTPA	Punitive, Compensatory	Common law; Ind. Code § 27-4-1

* This table provides a general overview only and does not constitute legal advice. Remedies vary based on specific facts, claim types, and recent case law. Most states provide some form of protection. Contact us if your state is not listed — you may still have a valid claim.

Contact Us – Free Case Evaluation

What to Include in Your Inquiry

If you believe your university health insurer denied or improperly limited a legitimate medical claim, please contact us using the form on our website or by calling (800) 424-6690. To help us evaluate your case as quickly as possible, please provide as much of the following information as you can.

(a)  The name of the university or college:  at which you are or were enrolled as a student at the time your claim was denied.

(b)  The name of the health insurance company:  that denied or improperly limited your claim. This typically appears on your insurance card or denial letter.

(c)  The date you purchased or enrolled in the coverage:  — typically the first day of the academic semester or year in which you enrolled in the plan.

(d)  How much you paid for the policy and who paid the premiums:  — for example, whether you paid directly, your parents paid, or the cost was included in your tuition billing or paid from student loan disbursements.

(e)  A description of the medical claim that was denied:  — the nature of your illness or injury, the treatment you sought or received, and the stated reason given by the insurer for the denial.

(f)  When the injury or illness occurred:  and whether it occurred within the past four years. This is important for evaluating whether your claim is timely under the applicable statute of limitations.

(g)  How your claim was ultimately resolved:  — for example, whether it was paid after appeal, remains denied, was partially paid, or whether you paid out of pocket.

(h)  Any additional harms you suffered as a result of the denial:  — for example, whether your condition worsened, you were forced to leave school, debt went to collections, or your family suffered significant financial hardship.

(i)  The amount of out-of-pocket expenses you incurred:  as a result of the denied claim — your best estimate of total costs you paid or owe that should have been covered.

Please Also Submit (if available):

• A copy of your denial letter from the insurance company, including any appeal denial letters
• Any correspondence between you, your medical provider, and the insurer regarding the denied claim
• A copy of your health insurance policy, certificate of coverage, or Summary of Benefits and Coverage
• Any Explanation of Benefits (EOB) documents received in connection with the claim

You do not need all documents to contact us. If you no longer have copies, we can advise you on how to request them.

About Berger Montague

Berger Montague is one of the nation’s preeminent law firms focusing on complex civil litigation, class actions, and mass torts in federal and state courts throughout the United States. With more than $2.4 billion in 2025 post-trial judgments alone, the Firm is a leader in the fields of complex litigation, antitrust, consumer protection, defective products, environmental law, employment law, securities, and whistleblower cases, among many other practice areas. For over 55 years, Berger Montague has played leading roles in precedent-setting cases and has recovered over $50 billion for its clients and the classes they have represented. Berger Montague is headquartered in Philadelphia and has offices in Chicago; Malvern, PA; Minneapolis; San Diego; San Francisco; Toronto, Canada; Washington, D.C., and Wilmington, DE.