this post was submitted on 01 Sep 2024
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‘Make your health insurance company cry’: One woman’s fight to turn the tables on insurers (sfstandard.com)
submitted 3 months ago by kalkulat to c/health
88 comments fedilink hide all child comments
 

"... The “dirty secret” of the insurance industry is that most denials can be successfully appealed..."

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[–] [email protected] 4 points 3 months ago (1 children)

I wouldn’t be surprised if ‘knowingly filing a false appeal’ is a reason to boot you off the plan in the first place.

For that to be an issue you would have to "know" it was false.

[–] chuckleslord 7 points 3 months ago (2 children)

You signed it, verifying that you knew what it entailed. That's what the comment was pointing out.

[–] NikkiDimes 8 points 3 months ago* (last edited 3 months ago) (1 children)

Usually when signing things off like this, it's affirming that you believe all statements to be true. They would have to prove you willingly lied, not that you were simply wrong, which is very difficult to prove legally.

That said, IANAL.

[–] [email protected] 2 points 3 months ago (1 children)

'Reckless disregard for the truth' shows up sometimes, especially in e.g. defamation.

If the AI cites some legal case from 2015 or a random medical article, you probably need to ensure that those articles actually exist, and not simply assume that the AI is right.

If the AI said that a month's supply of Fentanyl is the recommended treatment for a headache, no reasonable person is going to believe it. That means that if you say that you believe that, the court isn't going to consider you a reasonable person.

IANAL either.

[–] NikkiDimes 1 points 3 months ago

Hah true, true. If you don't read the output at all and do the most minimal of research, that's on you for sure.

Now excuse me while I pop some Fent, my head is killing me.

[–] madcaesar 3 points 3 months ago (2 children)

What's the legal code if you THINK something is true and you affirm it, but you are wrong. It can't be the same as lying since you thought it was true.

I really wonder what the law says on something like that.

[–] [email protected] 2 points 3 months ago

At least for something to be perjury there usually has to be "mens rea" (guilty mind).

[–] [email protected] 1 points 3 months ago

'Reckless disregard for the truth' shows up sometimes, especially in e.g. defamation.

If the AI cites some legal case from 2015 or a random medical article, you probably need to ensure that those articles actually exist, and not simply assume that the AI is right.

If the AI said that a month's supply of Fentanyl is the recommended treatment for a headache, no reasonable person is going to believe it. That means that if you say that you believe that, the court isn't going to consider you a reasonable person.