Articles Posted in Insurance Issues

According to Consumer Reports, insurance companies can withhold payment after a procedure or treatment is done even if they had previously approved the procedure or treatment. If the insurance company concludes that whatever you had done was not medically necessary, based on information uncovered after the procedure was performed, they can deny the promised payment. Dr. Marvin Lipman, a chief medical adviser to Consumers Union, states that medically necessary is “an iffy sort of qualification that can usually be verified by your physician.”

If the insurance still refuses to pay the claim, patients have the right to dispute the company’s decision. For more information and tips for dealing with denied insurance claims, please visit http://www.insure.com/articles/healthinsurance/claim-denial.html or http://www.fool.com/personal-finance/insurance/2007/01/25/fight-for-your-rights-health-insurance-claims.aspx.

Article Source: http://www.komotv.com/news/consumer/9659797.html

Washington State’s insurance commissioner Mike Kreidler fined Progressive Insurance group more than $150,000 after the company unlawfully calculated and charged incorrect premiums to more than 62,700 policy holders. From October 2005 through April 2006, both Progressive Classic Insurance and Progressive Northwestern Insurance companies used unapproved rates to calculate premiums for uninsured bodily injury and property coverage’s. The companies both undercharged and overcharged customers in Washington State. Once the mistake was realized, the company had already overcharged around $720,000. To date, the company has refunded around $341,645 to those overcharged customers. This is not the first time that Progressive has been charged for such infractions. The first violation occurred in 2005 and the company was fined $10,000.

The money paid in such fines is collected by the Insurance Commissioner and deposited into the states general fund. The fund supports various programs for Washington State residents. In 2006, the commissioner collected $2.2 million in fines.

Article Source: http://www.insurance.wa.gov/news/dynamic/newsreleasedetail.asp?rcdNum=567

An internet survey recently conducted by PNC Financial Services Group found that out of 1,000 consumers, close to one in four said they had a legitimate claim denied by their health insurance. Here are some helpful hints when dealing with denied claims:

1. Get Help: Seek help from your doctor, hospital business office, and employee benefits office. These offices can be a lot more powerful then you. Also seek help from the Patient Advocate Foundation, a non profit group who employs case managers specifically to help people work out insurance company issues.

2. Be Persistent: Appeal, appeal, appeal. “You may go through three or four levels of appeals before you get a favorable resolution” says Nancy Davenport-Ennis, co-founder of the Patient Advocate Foundation.

The Approve 67 campaign announced today that Washington consumers, progressives, seniors, firefighters and labor leaders have officially endorsed the Approve 67 campaign. The group is working to pass new consumer protections against unfair insurance industry tactics and trends to deny legitimate claims.

“Thousands of honest, hard working people in Washington are forced to fight insurance companies over legitimate claims each year,” said Sue Evans, spokesperson for the Approve 67 campaign. “Referendum 67 says the insurance industry must treat people fairly. It’s a law that is long overdue.”

Referendum 67 would require insurance companies to pay legitimate claims in a timely manner and holds them accountable if they do not. If voters approve 67 in November, insurance companies would face penalties for unfairly treating consumers with valid claims.
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Starting June 27th Safeco Insurance will offer “Teensurance” to its customers in 44 states. Teensurance is a new wallet sized tracking system that is mounted on the dashboard of a vehicle. The system allows parents to set limits for their teenage driver’s using the Teensurance web site. When the teenage driver exceeds the speed limit or travels too far from home or school, the parent automatically receives a message via phone call, text message, or email. The parent can also go online to see the car’s location.

Safeco will offer the service at $14.99 a month. They will not introduce insurance reduction rates until the company determines whether the program actually reduces the amount of collisions. Jim Havens, Safeco’s vice president, says that the device can also be used to monitor elderly drivers or vehicles in a small business fleet.

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Insurance adjusters are trained professionals whose goal is to settle your case as quickly and cheaply as possible. Every time you communicate with the insurance company their mindset is geared toward evaluating your claim in the light most favorable to their interests. Your bodily injury claim should never be settled on their terms or timetable. Tom Budinich at Bernard & Lindquist used to work as a bodily injury adjuster and he knows how insurance companies work. Without the legitimate threat of filing a lawsuit in your corner, an insurance company will never evaluate your claim for its true worth. Contact Bernard & Lindquist today and we can give you a free evaluation of your case and all of its components including medical bills, wage loss, and pain and suffering.

On Tuesday, May 15, 2007, Washington State Governor Christine Gregoire signed into law the Insurance Fair Conduct Act. This bill finally gives real penalties for insurance companies who unreasonably deny a claim or fail to pay benefits to their insureds.

The attorneys at Bernard & Lindquist have fought for passage of this bill. It has become standard practice in the insurance industry to “shave” off claim payments. For example, in the case of an at-fault driver who runs a red light and broadsides another vehicle, we commonly see an insurance adjuster arbitrarily assigning some percentage of fault on their own insured driver who had a green light. By doing this, the insurance company does not have to pay 100% of their insured’s vehicle damage or medical bills. These are benefits paid for by the insured in his monthly premiums. The amount “shaved” by the insurance company may total only a few hundred dollars per claim, but it saves the insurance industry executives millions.

Prior to passage of this law, an insured driver had no recourse but to accept the insurance adjuster’s low offer because if he filed a lawsuit he could only receive the amount the insurance company should have paid in the first place.