Think You Have Coverage? What Your Policy Really Covers May Surprise You

The definition of total disability is not standard and will vary from company to company and product to product. Total disability can be defined in different ways. Generally, it can refer to total disability where one is unable to perform the substantial and material duties of your own occupation commonly referred to as “own occupation” coverage. Or, it can refer to coverage if one is unable to perform “any occupation” for which you are reasonably educated, trained or suited. This is called “any occupation” coverage.

Blue Shield of California to Pay Los Angeles $2 Million for Bad Faith Claims

In late December, Blue Shield of California settled a bad faith insurance claim with the County and City of Los Angeles, agreeing to pay $2 million for withdrawing health insurance benefits after members became ill. The health insurer came under fire for engaging in what former Los Angeles City Attorney, Rocky Delgadillo, called “post-claims underwriting.”

Increased California Blue Cross Rates Lead to Class Action

November 11, 2011 – A class action lawsuit recently filed in California state court alleges that insurance giant Blue Cross engaged in illegal “bait and switch” tactics while increasing annual deductibles and premiums during the middle of a deductible year. The suit claims the company violated state laws, including the Knox-Keene Act which prohibits health care plans from using misleading advertisements and deceptive coverage descriptions.

Using the Universal Protocol to Avoid Medical Errors in California

In September 2011, the California Department of Public Health (CDPH) announced administrative penalties against 12 California hospitals for failure to meet licensing requirements that the CDPH determined caused or was likely to cause serious injury or death to patients.

When these failures occur, a patient who suffered serious harm as a result may be able to make a claim against the at-fault health-care provider in a medical malpractice lawsuit.

New York Life Required to Report the Number of Death Benefits They Have Not Paid

All life insurers licensed to do business in New York are now directed to report on how many death benefits they have not paid because they did not use the official government list of deaths to promptly identify when policyholders died, the New York Insurance Department announced today. To produce this report, the Department is requiring insurers to immediately begin using reliable available data to identify when policyholders have died and death benefits are due but unpaid. Meanwhile, the Department is working on a regulation to make this requirement permanent.