The momentum created by the Cunningham v. Aetna case in Oklahoma has contributed to a national trend of lawsuits being filed against health insurers who deny proton therapy to their policyholders suffering from cancer. Readers of this blog may will recall the Cunningham vs. Aetna case in Oklahoma County, Oklahoma in November, 2018. In that
As we frequently discuss on this blog, insurance companies owe a duty of good faith and fair dealing to their policyholders. Unfortunately, insurers regularly violate this important duty in a myriad of ways. This is not uncommon. However, it is very uncommon for an insurance company’s actions to be called out as forcefully as they
A high-profile California insurance bad faith lawsuit brought by Gillen Washington and his attorney Scott Glovsky against his health insurance company, Aetna, has now been settled. In this case, first reported on by CNN, evidence emerged in the form of the Aetna-in house doctor’s testimony that Aetna medical directors make decisions on policyholders’ claims without
United Healthcare (“UHC”), the largest health insurance company in America, was found by the California Department of Insurance to have committed over 900,000 violations of California laws and regulations. As a result, the California Insurance Commissioner imposed $173 million in fines. UHC challenged the fines in court, and in early January the California Supreme Court
A recent story in the Guardian reveals the statistics on how CEO pay at the largest US corporations has skyrocketed over the last few decades. The Guardian story says in 1965, CEO pay was 20 times that of workers. That would mean if a worker made $30,000.00 per year, the CEO would be making about
In an excellent recent article in the New York Times, a claim-handling practice by Anthem Blue Cross Blue Shield was brought into the public light. Anthem has begun denying its policyholders’ claims for coverage for emergency room visits if Anthem determines after the fact that the policyholder didn’t really need to go to the emergency
When you make a health insurance claim, oftentimes your health insurance company will have a doctor employed by the company review the claim to see if it should be paid. The problem I have seen in a number of cases is the doctors reviewing policyholders’ claims are horribly unqualified to make fair decisions on those
Because the health insurance industry has legal immunity in many situations from bad faith lawsuits, it operates differently in many ways than the remainder of the insurance industry. Health insurance companies do not tend to investigate and evaluate claims in the same manner as auto insurance or homeowners insurance companies. My experience prosecuting bad faith
CNN just ran an incredible story by Wayne Drash (see it here) on a health insurance claim denial by one of the country’s largest insurers, Aetna. The story involved the case of Gillen Washington, a 23-year-old Californian, who is represented by attorney Scott Glovsky. Apparently, Aetna denied medical treatment to Gillen based on the
“Quality Assurance” or “QA” is a familiar concept in lots of industries (like manufacturing for example), and the insurance industry has widely implemented QA operations in their business as well. Insurance companies say they want their adjusters to handle policyholders’ claims in a “quality” fashion. To be sure adjusters are doing so, insurance companies use