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

  • RobotToaster@mander.xyzEnglish
    0·
    2 months ago

    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.

      • NιƙƙιDιɱҽʂ@lemmy.worldEnglish
        0·
        2 months ago

        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.

        • SomeoneSomewhere@lemmy.nzEnglish
          0·
          2 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.

          IANAL either.

      • madcaesar@lemmy.worldEnglish
        0·
        2 months ago

        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.