LegalMatch: Personal Injury

Rescinded: Blue Cross Violating Health Insurance Laws?

The LA Times reported last week on a major violation of health insurance laws by the huge private health insurer, Blue Cross. (Or, as they’re now called in California, “Anthem Blue Cross”).

The California Blue Cross division is under fire for pre-planning rescissions. As I mentioned a few posts ago, rescissions are the heavy artillery behind insurance cancellation. They allow private insurers to find discrepancies in your original application (an abnormal PAP smear, for example) and swing on that “error” to retroactively deny you coverage. Their claim is that the omitted information would have altered their original decision to approve you for a plan, and in some cases that's a valid claim. But Anthem Blue Cross has apparently been taking this process a little too far—by planning their rescissions in advance, and acting against health insurance laws.

Rocky Degadillo, an attorney for the city of Los Angeles, even went so far as to say that “countless Californians who believe they have insurance actually have policies that aren't worth the paper they're printed on” [1]. Not exactly a reassuring sentiment for policy-holders who have already dished out thousands in monthly payments.

Those with individual insurance, such as many self-employed or unemployed citizens, are being hit the hardest.

While the HIPAA (Health Insurance Portability and Accountability Act) makes it easier for people with pre-existing health conditions to get insurance through work, health protection for individuals remains subject to cancellations via rescission, outright denials for pre-existing conditions, and exorbitant premiums and monthly charges.

 

What can I do if my health insurance plan has been rescinded?

If your policy was rescinded and you believe that it was done so unfairly, you may still be able to get coverage. If you are in California, you should be also aware that past rescissions by Blue Cross are currently being reconsidered, which means that you could get retroactive reimbursement for surgeries, procedures, and other work done if you were uninsured because of a canceled policy.

Get in contact with a personal injury attorney and explain your situation.

A few minutes of discussion can give you a professional look at your options and allow you to make an educated approach to getting your health insurance back and your debt repaid.

You can also discuss your policy or issues with your health insurance on our Personal Injury and Accident Law Forum.

by Kate Beall

"Slip and Fall" Fakers and Fraud Artists.

Faced with an episode of “America’s Funniest Home Videos,” someone unfamiliar with the States would probably conclude that we are a nation obsessed with infants, humorless voiceover, and serious personal injury.  But intentional personal injury—that’s a strange one.

Yet we see this kind of damage (or people faking it) all the time. We’re extremely familiar with the car-accident “victim” and his convenient case of whiplash, and we laugh about the shady stranger faking a dog bite wound.  But these aren’t just popular images from a syndicated sitcom. Occasionally, the insurance fraud artist becomes a feature in the very real, very modern news.

 

This “slip and fall” faker made the news last year after security cameras caught her pouring olive oil on a store’s tile floor. Returning later to “slip” on the pre-planned slick, the Florida woman made her cunning plan a little too obvious, and the store owner’s his $30,000 surveillance system caught the entire fraud on film. Unluckily for that woman, the film caught the internet by storm too.

Despite the glut of popular images about fake victims and insurance fraud criminals, dangerous property and building laws were put in place for a good reason: to protect. For property owners who don’t conform to the safety rules, the consequences can be serious. In this recent Texas case, over $75,000 is at stake because of a puddle of wax on a WalMart floor. Even a New York inmate is taking a stab at the pie with her case against the prison system, claiming that a “slip and fall” injury resulted from her shower-cleaning duties.

 

With so many cases to thumb through, how can we tell which ones are legit?

The legal system generally uses three criteria to determine whether a property owner is at fault:

1. The property owner caused the spill, worn or torn spot, or other slippery or dangerous surface or item;
2. The property owner knew of the dangerous condition but did nothing about it; or
3. The property owner should have known of the dangerous surface because a "reasonable" person taking care of the property would have discovered and removed or repaired it.

So, owners—keep your property in good repair, keep your customers safe, read up on personal injury laws, AND—

…consider installing a surveillance system.

by Kate Beall