Tampa Bay Personal Injury Lawyer - Insurance

New Change to HIPAA Protects Patient’s Genetic Information

C. Todd Alley — Tue, 13 Oct 2009 09:24:56 GMT

On October 1^st, the U.S. Department of Health and Human Services (HHS) issued new interim rules protecting patient’s genetic information from being used against them. The new rules come as the department interprets and implements the Genetic Information Nondiscrimination Act of 2008 (GINA), and serve to amend the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

The new rules also define genetic information, genetic services, genetic testing, and related terms and phrases. Genetic information is defined as "information about the individual's genetic tests or the genetic tests of family members… [and] family medical history." This definition also clarifies that "genetic information" does not cover information about an individual's sex or age.

Under the new rule, group health plans and issuers in the group market cannot:

Increase premiums for the group based on the results of one enrollee’s genetic information;
Deny enrollment;
Impose pre-existing condition exclusions; or
Do other forms of underwriting based on genetic information.

In the individual health insurance market, GINA similarly prohibits issuers from using genetic information to deny coverage, raise premiums, or impose pre-existing condition exclusions. Additionally, insurance companies are prohibited from asking individuals or family members to undergo a genetic test. A violation of any of the above prohibitions can lead to fines from $100 to up to $50,000 per offense.

HHS Secretary Kathleen Sabelius supported the new rule, saying “consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases.” This comes after stories of patients too afraid of having genetic testing done, for fear of becoming unable to obtain insurance.

Sebelius added, “Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.”

Some insurance industry representatives don’t see GINA as necessary. “It’s an anecdotal fear,” said Mohit M. Ghose, a spokesman for America’s Health Insurance Plans, whose members provide benefits for 200 million Americans. Nonetheless, the fear can compromise the health of patients too afraid of losing health insurance by undergoing genetic testing. GINA and the new interim rule looks to alleviate the patients’ fears, and doctors can now more efficiently diagnose and treat certain diseases early.

The new interim rule is open to public comment for 60 days. The rule will then become final, barring any setback.

Originally posted at InjuryBoard by C. Todd Alley

Dirty Little Secret in the Health Care Insurance World Is Exposed

Jim Clark — Tue, 23 Jun 2009 08:00:00 GMT

Health insurance policy holders would expect to be paying an insurance premium so that they are protected in the event of serious illness. But that’s not always the case when the insurance company no longer sees the policy holder as profitable.

A greedy, unethical, and downright sleazy practice held by some of the world’s largest insurance underwriters has been the practice of rescinding policies of its customers using the contract technicalities. Desperate to drop policy holders who become seriously ill (many of whom have been paying their insurance premiums for years), insurance companies have encouraged its employees to find ways to terminate the policy, saving the insurance company millions of dollars in health care cost a year.

In one case, a nurse diagnosed with breast cancer was dropped because she failed to disclose a visit to a dermatologist for acne. In another, a man was denied coverage when diagnosed with lymphoma for failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

This has been ongoing for years, but only recently has it come to light. One day after President Obama outlined his proposals for reforming America’s health care system, a congressional subcommittee convened to tackle the issue of insurance policy rescission. They called upon top executives and took turns grilling them, from both sides of the aisle. When asked the question, “Would your company stop the practice of rescinding policies absent intentional fraud?” The answer given by three industry leaders was “no.”

Rep. Joe Barton (R-Tex.) stated “if a citizen acts in good faith, we should expect the insurance company that takes their money to act in good faith also." Rep. Bart Stupak (D-Mich.) was more aggressive, saying “when times are good, the insurance company is happy to sign you up and take your money in the form of premiums, but when times are bad . . . some insurance companies use a technicality to justify breaking its promise, at a time when most patients are too weak to fight back." Stupak also used this opportunity to support a public choice option in health care, saying such an option would help keep health insurance agencies honest, since customers would have other reasonable options.

Clearly, the insurance companies aren’t willing to limit policy rescissions to intentional fraud, so the government needs to step in to protect its people. California has already proposed legislature, but a problem as universal as this requires federal legislation. It will not be surprising to see a proposal coming out of the ongoing subcommittee meetings, and everyone – those for health care reform and those against – should support it. It’s not a matter of politics. It’s a matter of ethics.

Originally posted at InjuryBoard by Jim Clark

Allstate Allowed to Write Policies in Florida Again

Shannon Weidemann — Wed, 23 Jan 2008 10:58:56 GMT

Last week Allstate was ordered by the Florida state insurance commissioner to stop writing insurance policies after their refusal to answer state subpeonas. The subpeonas were issued in an investigation into why Allstate wanted to raise their rates by 41.9 percent. Then on Friday the Court of Appeals issued an injuction allowing Allstate to write insurance policies again.

Before the ruling, McCarty said he stood by his decision Wednesday to suspend Allstate from writing new policies.
"This is just another step in the process that enables Allstate to further delay production of the documents we requested," McCarty said in a statement. "Allstate's motion is not unexpected, and it will not stymie my commitment to Florida's consumers to get to the bottom of this issue."

The court is giving the insurance commissioner till the 28th to argue its case on why the decision to suspend Allstate should be upheld. The Governor of Florida is asking residents to choose cancel their policies with Allstate and choose a different company to do business with.

Originally posted at InjuryBoard by Shannon Weidemann

Florida Supreme Court Overturns Flood Ruling

Shannon Weidemann — Sat, 22 Sep 2007 15:19:54 GMT

Damage from the 2004 Hurricanes in Florida brought about disputes between homeowners and insurance companies about what caused damage to homes. Conventional insurance companies pay out for wind damage and separate flood insurance policies pay for flood damage. Earlier court rulings said that insurance companies were responsible for flood damage. The Florida Supreme Court has ruled that insurance companies are not responsible for flood damage.

Just prior to the 2004 hurricanes, a South Florida district court had ruled that under Florida's valued policy law, insurers must pay policy limits when a covered property is destroyed, even if the damage was partly caused by an uncovered peril.
The so-called Mierzwa ruling exposed Florida's insurance industry to massive losses in the 2004 storms, and prompted the industry to ask the Legislature to rewrite the state's insurance laws to their favor.

Hundreds of insurance cases will now have to prove what percentage of damage to a home was caused by the wind. That may prove difficult in cases where there is nothing left to the home.

If you would like to read more about hurricane damage, please visit InjuryBoard's Hurricane Damage information page.

Originally posted at InjuryBoard by Shannon Weidemann

Protecting the Private Insurance Industry Rather than Children

Staff Writer — Tue, 21 Aug 2007 10:09:11 GMT

The Bush Administration is trying to restrict SCHIP (State Children's Health Insurance Program) from covering children whose families fall with 250% of the federal poverty guidelines. This new move comes after years of allowing these children to receive public health insurance. If the Administration is successful, millions of children will be left without insurance because their families can't afford the private insurance. By the way, the families who fall into this 250% category make $43,310 for a family of four. Anyone who is trying to raise a family knows this isn't a lot of money. In effect, the new restrictions squeeze lower middle income families so that the private insurance industry can make more profits.

Two opponents of the plan are quoted in the Wall St. Journal, "Max Baucus, the Montana Democrat who is chairman of the Senate Finance Committee, said he hopes the administration will reconsider the policy.

"I have real concerns that this new policy takes America's kids too quickly in the wrong direction," he said. "This drastic change in policy sets states up to fail and jeopardizes coverage for tens of thousands of children in low-income, working families. New policies like this warrant greater transparency before changes are made."

Health advocates attacked the move. "The administration's new requirements will effectively establish a new income limit for SCHIP at 250% of poverty," Kathleen Stoll, director of health policy for Families USA. "These policies will mean more children going uninsured for longer periods of time, and more children who will remain uninsured because they cannot afford SCHIP."

Originally posted at InjuryBoard by Staff Writer

Florida No-Fault: Pros and Cons

Staff Writer — Tue, 12 Jun 2007 14:45:19 GMT

The Legislature decides October 1st, 2007 if the personal injury protection (PIP) part of the Florida no-fault auto insurance law will "sunset" after being in use for 36 years. If PIP is not renewed, drivers will no longer be required to buy the minimum $10,000 coverage for PIP and will be able to bring law suits against other drivers in auto accidents.

The proponents of getting rid of PIP, mainly insurance companies, say that getting rid of the law will lower insurance rates. The average family savings could be up to $360 a year and State Farm has claimed that they will lower rates 16% for two car households if the law is done away with. Florida's PIP statute is costing Florida drivers over 1.7 billion dollars a year, making Florida's auto-insurance the 6th highest in the nation. The insurance companies also feel that this will reduce fraud and eliminate duplicate coverage. Advocates say that getting rid of PIP will hold drivers responsible for their accidents and will leave them more choices in choosing their own coverage.

The critics, however, assert that by abolishing this law, hospitals and trauma centers will bear the costs of patients that don't have health care insurance. In Florida, treating uninsured patients could cost up to $350 million a year. Consumer advocates believe that drivers will end up paying even more for insurance because they will have to add more coverage to protect themselves from uninsured drivers. Experts believe the number of uninsured drivers will be high; many people may simply go without the coverage if they're not required to have it.

Auto-insurance companies may not cover medical expenses unless the customer selects and pays extra, which many people may be unaware of. The courts will also be full of accident-related suits. If the no-fault law expires, people will be able to file suit against other drivers for auto accidents. People will have to pay one way or the other, with or without this law.

Originally posted at InjuryBoard by Staff Writer

I Like No-Fault Insurance Because State Farm Does Not

Bob Carroll — Wed, 21 Feb 2007 05:15:29 GMT

One advantage to practicing law in Florida for over 36 years is the perspective you have of automobile insurance in our state.

Prior to 1972 the No-Fault system and coverage did not exist. The insurance industry in Florida and across the nation did not like that situation. It argued for the need to enact restrictions on the right to sue for damages as a result of an automobile accident and to create the Personal Injury Protection insurance benefit (PIP), commonly called No-Fault.

Since 1972 Floridians have had to purchase $10,000 of PIP coverage (for medical expenses and lost income) along with whatever liability and other traditional coverages they desired.

At first, I was against PIP (No-Fault). Then, as thousands of clients were benefited greatly by the relatively prompt payment of medical expenses and lost income I became a supporter.

Now, with No-Fault scheduled to sunset in October, 2007, unless the Legislature acts to save it, I have become an advocate for retention of the system. My support of the present system (which could use some tweaks) is bolstered by the obvious enthusiasm of some insurance companies for its impending demise. The following article posted at tampabays10.com is an example.

State Farm would cut car insurance rates if no-fault expires

WINTER HAVEN, Florida (AP) -- State Farm says it will cut its car insurance rates by about 16 percent if the state's no-fault accident system ends in October as scheduled.
In a state regulatory filing, State Farm says its customers can expect to save about $360 a year on average for a two-car household if the state's no-fault auto insurance system isn't retained by state lawmakers. The individual changes will vary widely depending on coverages, discounts, geography and driver and car details.
The no-fault system requires drivers to get $10,000 in personal injury protection coverage, but puts restrictions on people's right to sue if they are hit in an accident and injured.
The system was meant to try to lessen the number of lawsuits. But some insurance companies say it has been beset with fraud.

Notice the beset with fraud line. My observation of the No-Fault system over a 34 year period is that fraud is minimal, but the system is beset with incompetent claims processors within the insurance industry. But, as they say, that is another story.

Originally posted at InjuryBoard by Bob Carroll

Annuities Sometimes Are Unwise Investments

Bob Carroll — Mon, 18 Dec 2006 13:26:19 GMT

When is an annuity a scam played on the purchaser? I nominate the circumstances of this purchaser's dealings with an insurance agent in New Port Richey.

The Great Annuity Rip-Off

Seven years ago, when Alice Bouchard was 85 and needed her money to be easily accessible, an insurance agent sold her a deferred annuity that tied up her money until she was 101. If she had needed to withdraw the money during the first five years after buying the annuity, she would have paid a massive 25% surrender charge.
And if that weren't bad enough, the agent paid Bouchard regular annual visits and persuaded her to sell the annuities she had purchased in past years and buy new ones. Each time, she had to pay surrender charges. Then, she says, without her knowledge the agent began shifting money to other family members after she reached 90 (the maximum age at which you can buy an annuity from most companies).
Bouchard, who lives in New Port Richey, Fla., and her daughter, Sister Carole Bouchard, a member of the Society of Sisters for the Church, eventually sought the advice of a financial planner, who contacted the Florida Department of Financial Services. Investigators discovered that Bouchard had paid more than $6,500 in surrender charges and taxes, and she had lost ownership of $293,000 that had been transferred to various members of her family. The agent had cleared $138,000 in commissions.
The agent preyed on Bouchard's fear of losing money by promising that she'd get the benefits of investing without the risk--a typical ploy of salespeople who push unsuitable annuities, regulators say. And it's a ploy that seniors and people nearing retirement will encounter more frequently.

This is far from a unique story about the sales of many insurance products and annuities to the elderly. All we civil trial lawyers can do is to try to correct the harm that has been done and recover the money lost. Family members have to be the initial guardians of the assets of their older relatives - unless they are dipping into the honey pot themselves.

Originally posted at InjuryBoard by Bob Carroll

Civil Justice For Florida's Injured Snowbirds

Bob Carroll — Mon, 18 Dec 2006 07:23:52 GMT

Last week I was working on a personal injury claim on behalf of two Canadian citizens who were visiting in Florida when they were involved in an automobile accident. This week I believe my calendar shows two matters involving injured snowbirds from northern states. The fact is that Florida, perhaps more than any other state, has lots of out-of-state residents on its roads. And, as a result, many of them are seriously injured.

Most out-of-staters bring with them insurance policies which may have to be used to accomplish full compensation for the injuries sustained. This is especially true regarding No-Fault, Medical Payments and Uninsured Motorist Coverages. My staff and I have to carefully review these policies, research Florida and out-of-state law, and do what we can to navigate the complications and roadblocks that arise.

Now, we have to contend with a new opinion of the Florida Supreme Court which may put some of our snowbird clients at a disadvantage in making their claims for just compensation.

Supreme Court: Florida Insurance Law Doesn't Cover 'Snowbirds'

"Snowbirds'' and other part-time Florida residents who insure their cars back home cannot make claims under Florida laws that may be more favorable to them than those in their own states, the state Supreme Court has ruled.
The ruling applies to crashes or other damages that occur in Florida. It was unanimous, but Chief Justice R. Fred Lewis agreed only with its result. He wrote that the majority's sole reliance on where a policy is issued may result in unintended consequences.
The opinion quashed a 2nd District Court of Appeal decision to permit a lawsuit under Florida law against Bloomington, Ill.-based State Farm for a claim on an Indiana policy.
The Supreme Court said only Florida citizens, not visitors or part-time residents, can claim the benefits of Florida law under out-of-state insurance policies and only then if necessary to "promote a paramount public policy.''
"Although Florida welcomes its many visitors, whether for short or extended stays, we cannot rewrite their out-of-state contracts,'' Justice Raoul Cantero wrote for the high court.
The decision will prevent Lake Wales residents Thomas and Margaret Roach, who were injured in 2001 while riding in a neighboring couple's Indiana-insured car, from suing State Farm for underinsured motorist compensation under Florida law.
Indiana law would prohibit them from recovering because it permits an offset of underinsured motorist coverage against claims paid under other types of coverage. Florida law does not permit offsets.

Originally posted at InjuryBoard by Bob Carroll

How Good Is Your Primary Care Doc And Your Health Insurance Company?

Bob Carroll — Fri, 03 Nov 2006 05:50:04 GMT

Gooznews.com asks a question all of us should answer.

How Good Is Your Primary Care Physician?

Everytime I hear or read that the U.S. health care system is the best in the world, I wonder why we wind up so low on so many basic indicators like longevity and infant mortality. A study out today that focuses on primary care -- that first interface with the health care system -- helps explain why.
A Commonwealth Fund survey published in Health Affairs asked 6,000 primary care physicians in the U.S., U.K., Germany, Australia, New Zealand, Canada and the Netherlands about their practices.
Primary care doctors in the U.S. are less likely . . . to be able to offer patients access to care outside regular office hours or to have systems that alert doctors to potentially harmful drug interactions. U.S. primary care physicians are also less likely to receive financial incentives for improving patient care.
Only about a quarter of primary care doctors in the U.S. (28%) and Canada (23%) use electronic medical records, compared with a large majority of primary care doctors in the Netherlands, (98%), New Zealand (92%), the U.K. (89%) and Australia (79%).

Thank you, Merrill Goozner, Gooznews.com.

Allow me to answer Merrill's question for a number of my clients in Florida over the past 35 years. Unfortunately, some primary care physicians appear to be lax or disinterested. Some are extraordinarily pro active and knowledgeable. But, some seem to be sleepwalking their way through the medical lives of some of their patients.

I do not have an easy suggestion for improving this situation. A significant part of the problem is the extremely low reimbursement rate paid by insurance companies for primary care office visits. Then, there is the coverage grief frequently encountered when a primary care doctor wants to pro actively undertake a series of expensive tests. For example, just how many times will a primary care physician go to bat for an MRI or CT Scan after losing a couple of three month battles with a health insurance company.

Maybe we can add to Merrill's question a second one: How Good Is Your Health Insurance Company?

Originally posted at InjuryBoard by Bob Carroll