If your health care provider has determined that certain medical treatment is needed, but your HMO or health insurer doesn't agree, this law allows you to appeal. Under the Appeals and Grievances Act, the Maryland Insurance Commissioner has the authority to overturn your health plan's decision if it is determined that your treatment is medically necessary. When an HMO or health insurer denies coverage for treatment, you must do so in writing. After an adverse decision or denial, your health plan must provide you with the details of its internal grievance process so that you can file an appeal with your health plan, if you so wish.
Keep in mind that if your complaint is considered an emergency, you do not have to file an appeal with the health plan before contacting the Maryland Insurance Administration. File your appeal complaint and grievance in writing (see the How to File a Complaint section below) and provide copies of all documentation relevant to your case (for example, the denial letter from the health plan, medical records, etc. (The Insurance Administration has medical experts who will review your case). Once the Insurance Administration has concluded its investigation, you will be immediately notified of the final decision.
In cases of emergency, a decision must be made within 24 hours. If you need help filling out these forms or would like to send them to an agency representative, visit us at one of our Consumer Outreach offices. The State of Maryland is committed to providing voters, businesses, customers and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, truthful and transparent services. We are available on the following channels.
The appellants or the deceased they represent (hereinafter collectively referred to as “appellants”) claim to have suffered bodily injury due to exposure to products containing asbestos manufactured or sold by Pittsburgh Metals Purifying Company (“PMP”). The appellants contend that, like the proposed interveners in Mountain Top, they have a legally created interest in Liberty Mutual's UEL policies under the Pennsylvania Insurance Insolvency Act (the “Act”). The current situation is likely to cause unfair discrimination against state insurance companies and encourage out-of-state insurance companies to choose a federal court. The Seipels, a couple who owned two condominiums that had been damaged by the hurricane, filed a lawsuit in a territorial court alleging that the Board had violated the statutes of the MTCA by, among other things, failing to appoint an insurance trustee to manage the distribution of insurance revenues.
The appellants do not cite any supervisory authority to support their argument that plaintiffs who have filed tort lawsuits against the insured can fully intervene in a declaratory judgment action on insurance coverage between the insured and their insurer. Mountain Top was referring to the disbursement of insurance revenues that the insurance company had already paid to a condo association to compensate for a loss caused by a hurricane. The appellants argue that the district court made a mistake in relying on Pacific Indemnity because Liberty Mutual has been compensating PMP for the asbestos-related injuries of thousands of personal injury plaintiffs for years. According to them, if they are not allowed to intervene and Liberty Mutual “evades its defense and compensation obligations under the policies, the interveners will not have any adequate remedy in their underlying action.”.