On June 7, 2026, millions of soccer fans around the world watched in horror as Danish star Christian Eriksen crumpled to the ground during a pre-World Cup friendly against Ukraine.
Play stopped as teammates rushed to his side. For the first time all game, silence fell over the stadium.
The story has a happy ending, though: Eriksen stood up,walked off the field under his own power, and was reported conscious and recovering well. The Danish Football Union confirmed that his implanted cardiac device had activated exactly as it was designed to do.
This is the second time that Eriksen has needed life-saving measures for a heart problem on the field. The first time, in 2021, he was playing in a European Champsionship game when he went into cardiac arrest. That time, he needed CPR. After he recovered, his medical team opted to implant an ICD (an implantable cardioverter-defibrillator) into his chest. Just a few weeks ago, his ICD responded to a dangerous heart rhythm and kept him alive and able to walk off the field under his own power.
Eriksen’s continued ability to play professional sports, and his rapid recovery from potential cardiac arrest, are testaments to the power of modern medicine. However, it’s also a reminder of something that’s less likely to make headlines. In the US, many patients struggle to get insurance approval for potential life-saving ICDs and other medical devices due to the cost.
If a health insurance claim denied for amedically necessary device or procedure is denied, it can lead to a life-or-death legal battle. Unfortunately, the fight may even fall to patients’ families, when insurance approval is delayed or denied until it’s too late.
What Is an ICD, and Why Would an Insurer Deny It?
An implantable cardioverter-defibrillator is a small device surgically placed in the chest of a patient who is at risk for what doctors call a malignant arrhythmia. These arrhythmias are sudden, dangerous disruptions in the heart’s electrical activity.
You can think about the heart as having both plumbing and an electrical system. Most people are familiar with blockages in the plumbing side, the kind that cause heart attacks. However, electrical failures are just as deadly, and they can happen without warning.
An ICD monitors the heart continuously. If it detects a life-threatening rhythm, it delivers an electric shock to restore normal function. If you’re familiar with the defibrillators you can find on the walls of public places, this is essentially a smaller, built-in version of those. For patients at risk, an ICD isn’t a luxury, anymore than an Epi-Pen is a luxury for people with serious allergies. Having one can be the difference when it comes to survival in a health emergency.
So why would a health insurer refuse to cover one? There are two answers. The first is framed in clinical language: the insurer’s medical reviewers may conclude that the patient doesn’t meet specific clinical criteria, that the treatment is “not medically necessary,” or that less invasive options haven’t been exhausted. These determinations are sometimes made by personnel who have never met the patient, reviewed by algorithms designed to limit cost, and issued as form letters.
The second, more honest answer: ICDs are expensive, and insurance companies are companies first and foremost. They don’t want to pay for any procedure or device that they can reasonably deny, livesaving ICDs included.
Why Some California Residents Have More Options Than Others
If your health insurance denied coverage for a medically necessary procedure or device, the first question a California insurance attorney will ask is not “what did the denial letter say?” It’s: “What kind of health insurance do you have?”
Most Americans who get health insurance through a private employer have what’s called an ERISA plan. ERISA, the Employee Retirement Income Security Act, is a federal law that governs most employer-sponsored benefit plans in the private sector. ERISA limits what a policyholder can do when a claim is wrongfully denied, and generally prevents you from suing your insurer for bad faith, even if their conduct was unreasonable or harmful. If you win your case, the most you can typically recover is the value of the denied benefit itself, not damages for the harm the denial caused.
However, a significant chunk of California plans fall outside ERISA’s reach, and those policyholders have much more legal leverage. When comparing ERISA vs non-ERISA health insuranc, California law gives non-ERISA policyholders the ability to bring a bad faith claim against an insurer that wrongfully denied coverage. They can potentially recover not just the cost of the denied treatment, but additional damages caused by the denial. In fact, in cases of particularly egregious conduct, policyholders may even receive punitive damages.
Non-ERISA health insurance typically includes:
- Plans covering California public employees and their dependents, such as those administered through CalPERS
- Plans covering employees of public school districts and universities
- Plans covering employees of religious institutions
- Individual plans purchased directly, including through Covered California
If you or a family member have health coverage through a government employer, a public school or university system, a religious institution, or a plan you purchased on your own, you may have more options, legally, than if you were insured through a private employer.
What Bad Faith Looks Like in a Health Insurance Context
California law requires insurance companies to act in good faith when evaluating claims. When a health insurer denies a claim for a medically necessary treatment, there are two possible legal paths, depending on how the denial was handled.
- Breach of Contract: In short, the insurer got it wrong. The procedure was covered under the policy terms, and the denial was incorrect. In that case, the remedy is typically the value of the denied coverage.
- Bad Faith: The insurer didn’t just get it wrong, but did so unreasonably. For example, they might have denied coverage without a genuine clinical review, used medical criteria not actually supported by the insurer’s own policy, failed to investigate a claim adequately, or used delay tactics designed to make policyholders give up.
When a Denial Has Permanent Consequences
Most health insurance disputes are resolved before they become tragedies. A claim gets denied, a patient appeals, a doctor provides additional documentation, and coverage is eventually granted. If you’re the patient in one of these situations, it’s frustrating and time-consuming, but ultimately you get the help you need.
Other cases don’t end so happily.
Insurance attorney Demián Oksenendler has handled cases in which a wrongful denial of a lifesaving medical device was not caught in time. In one such case, resolved in the past year, a family lost their father because his health insurer refused to approve an ICD implant surgery, and had to pursue a wrongful death claim.
The insurer disputed whether the device would have made a material difference. Oksenendler argued that it would have, pointing to documented examples of patients with the same type of cardiac risk who received the device and, because of it, survived dangerous arrhythmia events that would otherwise have been fatal.
The World Cup stage has now provided the clearest version of that argument yet: professional athletes competing at the highest level of international sport, surviving on-field cardiac events because they had ICDs in their chests.
The case was resolved for the family, but even a successful lawsuit can’t bring back their father.
The ERISA Wall: Who Can Get Around It
If the family in that case had been covered by a typical employer-sponsored ERISA plan, their legal options would have been severely limited. They might have been able to recover the cost of the surgery that was denied, but little else. The law would not have allowed them to pursue the full scope of damages that reflects what the denial actually cost.
Because the coverage in that case was through a public employer, a plan not governed by ERISA, California’s bad faith framework applied. The family was able to pursue claims that reflected the true impact of the insurer’s decision.
What to Do If Your Health Insurer Denies a Medically Necessary Claim
If you receive a denial for a procedure, device, or treatment that your doctor says you need, there are several steps worth taking immediately:
1. Get the Denial in Writing
Read the denial and make sure you understand the stated reason. Insurers are required to explain the basis for their decision. That explanation matters both for an appeal and for any future legal claim.
2. Understand Your Health Insurance Plan
Check whether your insurance comes through a public employer, a religious institution, or was purchased individually. If so, you may have options that private-sector employees do not.
3. Don’t Make Assumptions
Don’t just assume the internal appeals process is your only path. Appealing through the insurer’s own process may be required before you can take legal action, but it’s not the only solution. If your appeal is denied, a California insurance attorney can evaluate whether the insurer’s conduct crossed into bad faith territory.
4. Get Started Sooner Rather Than Later
Fourth, act sooner rather than later. California law imposes time limits on insurance claims. For bad faith tort claims, the statute of limitations is typically two years from the date you knew or should have known of the denial and its consequences. Waiting too long can eliminate your ability to bring a claim.
Don’t Let Non-ERISA Insurance Denials Put Your Life at Risk
Christian Eriksen is alive today because doctors implanted a device in his chest. He walked off a soccer field under his own power because a medical decision made years ago was implemented without interference from a greedy insurance company.
Not every patient is that fortunate. Some patients with the same medical need, risk profile, and doctor’s recommendation are denied the same intervention. Sometimes the denial is corrected on appeal or by a court, but sometimes the correction comes too late.
If you are a California resident who has been denied coverage for medically necessary treatment, and especially if your insurance is through a public employer or another non-ERISA plan, you may have more options than you realize.
Demián Oksenendler is a California non-ERISA health insurance attorney who represents policyholders in disputes against health insurers, including wrongful denial cases involving non-ERISA plans. If your insurer has denied a claim that your doctors say is medically necessary, contact Oksenendler Law, P.C. to discuss your options.
