Insurance Claims And Issues

Considering Changing Health Insurance Plans? Look Before You Leap.

    It is not a good thing to switch Health Insurance Plans on a whim.  The switch should be done only after lots of homework, when it is done at all.

    Things to compare in making a switch of Health Insurance Plans, if switching at all, include:

            Premium;

            Deductible;

            Co-payment;

            Prescription Coverage if any, and Limits;

            Annual maximum out of pocket;

            Total lifetime benefit; and

            Last but never least, whether your own doctors participate "in network".

    Over all, you may have to choose also between an HMO or health maintenance organization type of plan, and a PPO or preferred provider organization plan.

    Practically and economically, compare too whether your current Health Insurance Plan compared to any possible alternative plan, would cover or exclude pre-existing conditions.

These and other considerations and a possibly helpful link or two, may be found in this newspaper report by Nancy Trejos, "With Out-of-Pocket Medical Expenses Rising, it Might be Time for Insurance Change" (Washington Post.com, Sunday, December 7, 2008).

These are some of the things that a person who is considering switching Health Insurance Plans should be advised to take into account.

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Employer-Provided Health Insurance Plans: "One Way, or No Way!"

    Annual deductibles of $1,100 and more for an individual will reportedly be common in the next year.

    That is, if the individual is fortunate to work for an Employer which offers a Health Insurance Plan at all.

    Deductibles on Family Coverage will be even higher.

    Health Insurance Plans with high deductibles were introduced in 2002.  Such Plans have understandably not received good reviews from Employees.  Employees have declined to participate in such Plans where their participation was voluntary.  "But this year, at more than 100 large companies and hundreds of smaller ones, the high-deductible plans are the employer's single take-it-or-leave-it option."  Milt Freudenheim, "Workers See Health Care Menu Shrink" p. B1, col. 1 (New York Times Nat'l Ed., BusinessDay Section, Saturday, November 15, 2008).  See also Lisa Girion, "Deductibles March Higher for Employer-Provided Health Insurance" (Los Angeles Times Online, Thursday, November 20, 2008); Anika Myers Palm, "Employees Dig Deeper in Pockets" p. C1, col. 5 (Orlando Sentinel, "Business & Money" Section, Thursday, November 20, 2008).

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Florida O.I.R. Lifted Suspension of New Allstate Policies...

... The Same Day Florida's First District Court of Appeal Denied Rehearing of its Opinion Upholding O.I.R.'s Order Suspending New Allstate Policies.

     Press reports published on Saturday, May 17, 2008 made it appear that the Florida Office of Insurance Regulation (O.I.R.) lifted its suspension on new Allstate Insurance Policies on Florida on the day before, or Friday, May 16, 2008.  As you will recall, the O.I.R. issued its Suspension Order in the first place because Allstate failed to comply with O.I.R. subpoenas for various groups of documents including unauthorized Catastrophe Computer Models purchased by Allstate in connection with its Premium Rate Increase requests.

     According to the O.I.R., it announced a stay of its Suspension Order on Wednesday, May 14, 2008, immediately after the Florida appellate court denied rehearing of its Opinion upholding the O.I.R. Order.  The reason given by the O.I.R. was its receipt of a sworn affidavit from Allstate "certifying that it has complied with Florida law by freely providing all documents requested" by the O.I.R.  See Florida Office of Insurance Regulation Press Release, "Florida Insurance Commissioner McCarty Stays Allstate Suspension, Continuing Compliance Required," Wed., May 14, 2008.

     Dennis Wall, Chair of the Insurance Law Committee, will speak at the Orange County Bar Association Center in Orlando, Florida about Preparing for Hurricane Insurance, on Wednesday, May 21, 2008 from Noon to 1:00 P.M.  The Orange County Bar Association Center is located at 880 North Orange Avenue in Orlando, Florida.

    You are cordially invited to attend this free public event.  Hope to see you there. 

Please Read The Disclaimer.

Florida Deductibles and Hurricanes.

     Many people hold Homeowner's Insurance Policies and other Property Insurance Policies that have one deductible.  That one deductible is large, in general terms, because it is written to address Hurricane Claims and all other kinds of claims on the policy.  See the suggestion to split deductibles so as to have one deductible for Hurricane Claims, and one deductible for all other kinds of claims on the policy, in this    Letter to the Editor by Mr. David Morris, published Saturday, May 10, 2008 by South Florida Sun-Sentinel.com.

    Where there is a separate Hurricane Deductible, Florida has a statute requiring not less than 18 pitch typeface or point, and also requiring certain wording.  There are additional requirements imposed by a different section if the Policy in question is residential.  However, to date 5 Federal Cases have involved the Florida Hurricane Deductible Statute and the result at this time is that the statute does not provide any penalties, so there are no penalties for its violation.  In one Federal case, an insurance company was found to violate the statute both by using unmandated language and by not using 18 point type to describe its Hurricane Deductible -- and the Policy was still in full force because the Statute still does not provide a penalty. 

Please Read The Disclaimer.
You are invited to "Prepare For Hurricane Insurance," a free presentation of the Insurance Law Committee at the Orange County Bar Association Center, 880 North Orange Avenue, in Orlando, Florida on Wednesday, May 21, 2008.  Dennis Wall, the Chair of the Insurance Law Committee, will be speaking from Noon to 1:00 P.M. on this and other Hurricane Insurance topics.  You will be welcome to attend this free presentation.

"Review Insurance Policies Now" Says Orlando Newspaper.

   Good advice with related links in this newspaper article published in the Orlando Sentinel, February 22, 2008, by Greg Groeller, "Review Insurance Policies Now".  Every Policyholder and their Agents and Brokers holding every kind of Insurance Policy can benefit from following the good advice published by this linked newspaper article.

Please Read The Disclaimer.

Health Insurance, Service, Premiums ... and Florida?

   The New York Attorney General has reportedly started investigations into allegations that Health Insurance Companies are steering Policyholders toward only medicalcare providers who are "in network" because the Health Insurance Companies allegedly pay even less than they might owe under the Policy toward the costs of "out of network" providers.  This development was posted here on Friday, Feb. 15, 2008.  On the geographical expansion of this issue, see this Sunday Editorial by a Florida newspaper:

Florida Attorney General Bill McCollum's office said it would look into the New York case to see if it has jurisdiction to act here in the matter.  Cuomo is earning a reputation as an aggressive defender of consumer rights.  McCollum should follow his lead.

St. Petersburg Times Editorial, "Insurer Pays a Little so Patient Pays a Lot" (St. Petersburg Times Online, Sunday, Feb. 17, 2008).

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Results Are In, Testimony to Continue.

    After 2 days of testimony under oath by Insurance Company representatives, the Florida Senate has learned that the Insurance Companies view their rate hikes as justified.  Julie Patel, "Insurance Companies in Florida Used Loophole in Law to Bypass Required Rate Savings/Companies Used Loophole to Justify Increases" (South Florida Sun-Sentinel.com, Ash Wednesday, February 6, 2008).  More hearings are scheduled on the Premium prices charged by some Insurance Companies for Homeowner's and other Property Insurance, and on what Catastrophe Models they base their claim for increases which have all been denied in Florida.

     It is not known for a fact, but after the revelation yesterday that Insurance Companies view their own rate hikes as justified, perhaps the next hearing will feature testimony, under oath or otherwise, that the sun rises in the east and sets in the west.

Please Read The Disclaimer.

Insurance Questions Before Catastrophes.

    If possible, the time to address Insurance Questions for Catastrophes is before a Catastrophe happens.  Many kinds of different Coverages, with links provided to useful resources, are addressed in this very good single-source-resource newspaper article:  by Renae Merle, "Covered For Catastrophe?" (washingtonpost.com, Sat., Jan. 12, 2008).

Please Read The Disclaimer.

QBE Insurance Group "Protects" Itself With "Derivatives Hedges".

    The good news to add to the headline of this post is that QBE reports that its major financial portfolio does not include "direct investments" in subprime mortgage schemes or CDO's in the United States.

    The bad news is -- besides as the above headline indicates, that QBE actually states that it is "'substantially protected through derivatives hedges'" --  that QBE in addition admits that it has "indirect investments" in those downgraded securities in the United States because it has investments in banks.  QBE refuses to elaborate, it is reported by Brett Miller, "QBE Says Its A$1.7 Billion of Equities Are Hedged (Update 2)" (Bloomberg.com, Wed., January 23, 2008).

    QBE Insurance Group Ltd. is Australia's largest Property and Casualty Insurance Company.

Please Read The Disclaimer.

Florida Laws and Hurricane Deductibles: Damages or Declarations.

     Florida has a lengthy statute which addresses Hurricane Deductibles. The Florida Statute, Sub-Section 627.701(4)(a), applies to policies issued or renewed on or after May 1, 2005. This effective date reflects the Florida visitation in 2004 of Hurricanes Charley, Frances, Ivan and Jeanne, and the 2005 visitation of Hurricane Wilma. This lengthy Florida Statute has now given rise to 5 lengthy Federal Court opinions. Any discussion of the statute and these cases is difficult, and a short discussion runs the risk of leaving out something important. This discussion will be kept as short as possible in this post in order to point out how the Florida Legislature and at least 5 Federal Court rulings in Florida have so far treated the recent use of Hurricane Deductibles.

     The Florida Hurricane Deductibles Statute requires certain language in specified pitch or points:

Any policy that contains a separate hurricane deductible must on its face include in boldfaced type no smaller than 18 points the following statement: THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU." A policy containing a coinsurance provision applicable to hurricane losses must on its face include in boldfaced type no smaller than 18 points the following statement: "THIS POLICY CONTAINS A CO-PAY PROVISION THAT MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU."

     Personal lines residential property insurance policies containing a separate Hurricane Deductible and that are subject to the Florida Statutes, must also comply with the following requirements of Sub-Section (4)(b) of Section 627.701:

Beginning October 1, 2005, for any personal lines residential property insurance policy containing a separate hurricane deductible, the insurer shall compute and prominently display the actual dollar value of the hurricane deductible on the declarations page of the policy at issuance and, for renewal, on the renewal declarations page of the policy or on the premium renewal notice.

These statutory provisions have caused a Hurricane of Judicial interpretation in 5 reported rulings by 3 Federal Judges. All 5 available rulings have been made in Federal Cases in the Southern District of Florida.