Insurance Denied Life-Saving Medication? Why Failing to Appeal Can Cost Everything
When an insurance company denies coverage for a medication your doctor says you need, it feels wrong. When that denial is followed by a serious injury—or even death—it feels unthinkable.
Many families assume that if the worst happens, they can sue the insurance company later.
A recent federal court case shows why that assumption is dangerously wrong. This article explains what happened, why the lawsuit failed, and the single mistake that resulted in the loss—so you don’t repeat it.
The Real Case Behind This Warning
Cannon v. Blue Cross & Blue Shield of Massachusetts (1st Cir. 2025)
What happened:
A patient with asthma was covered under an employer health plan
His doctor requested coverage for a specific inhaler
Blue Cross denied the medication, citing “step therapy” rules
The patient did not file an insurance appeal
He later died from asthma-related complications
His family sued the insurer for wrongful death and punitive damages
The result:
➡️ The court dismissed the case entirely.
Not because the denial was medically correct. Not because the harm wasn’t serious.
But because of how insurance law works—and what the patient did not do.
Why the Family Lost — Even After a Death
The court ruled that the lawsuit was blocked by a federal law called ERISA (Employee Retirement Income Security Act).
ERISA governs most employer-provided health insurance plans. And it has one rule that most consumers never learn until it’s too late:
If your claim involves a denial of benefits under an ERISA plan, you usually cannot sue the insurer for damages, even if the denial causes severe harm or death.
Instead, ERISA forces disputes into a narrow system:
Internal insurance appeals
Administrative records
Limited remedies
And once that window closes, it often closes forever.
The Fatal Mistake in This Case
Here’s the most important fact:
❌ The patient never appealed the denial.
That single failure mattered more than:
The severity of the illness
The alleged medical error
The tragic outcome
Why?
Because under ERISA:
The appeal is the record
Courts generally only review what was raised during the appeal
If no appeal is filed, there is often nothing left to review
The family tried to argue:
“This isn’t about benefits—it’s about wrongful death”
“The patient is gone; he couldn’t appeal”
“This is negligence, not insurance law”
The court rejected all of it.
Why Courts Keep Saying “No” in These Cases
Courts across the country have repeatedly ruled that:
You cannot bypass ERISA by re-labeling a denial as negligence or wrongful death
You cannot seek punitive damages for benefit denials under state law
You cannot sue later if the claim should have been appealed earlier
From the court’s perspective, the key question is simple:
“Could this dispute have been addressed through the insurance appeal process?”
If the answer is yes, ERISA usually preempts everything else.
Common Myths That Hurt Consumers
Let’s clear up dangerous misconceptions:
❌ “We can sue later if we don’t appeal”
Often false. ERISA severely limits lawsuits.
❌ “This is medical malpractice, not insurance”
Coverage decisions are treated as insurance issues—even when health outcomes are involved.
❌ “Appeals don’t matter if the insurer won’t budge”
Appeals create the record courts rely on later.
❌ “The insurer will explain what to do”
Denial letters are often vague by design.
What This Case Teaches Every Consumer
This case sends a harsh but critical message:
If your health insurance denies care, the appeal may be your only real chance.
Not appealing can:
Eliminate future legal options
Prevent courts from reviewing the denial
Lock in the insurer’s decision permanently
Appeals are not paperwork exercises. They are your leverage.
What You Should Do Immediately After a Denial
If you or a loved one receives a denial for medication, treatment, or care:
Step 1: Read the Denial Letter Carefully
Look for:
Reason for denial
Policy citations
Appeal deadline
Step 2: File an Appeal — Even If You Think It’s Hopeless
You are building a record, not just asking for mercy.
Step 3: Use the Right Arguments
Appeals must address:
Medical necessity
Policy language
Clinical evidence
Emotion alone won’t work.
Step 4: Meet the Deadline
Missing it can permanently bar relief.
Why Many Appeals Fail (and How to Avoid It)
Many people lose appeals because:
They don’t know what arguments matter
They submit incomplete records
They rely on short, emotional letters
They miss deadlines
Insurance companies know this.
That’s why AppealTemplates.com exists.
Don’t Let a Denial Become a Dead End
The tragedy in Cannon v. Blue Cross wasn’t just the denial.
It was the missed opportunity to fight it the right way.
If your claim was denied:
Don’t wait
Don’t assume you can sue later
Don’t rely on guesswork
👉 Use an attorney-written appeal template designed for insurance denials
👉 Learn what language insurers and courts actually look for
👉 Protect your rights before ERISA shuts the door
