Health insurers have begun submitting their proposals for approval of next year’s health insurance rates. For hundreds of Affordable Care Act (ACA) plans, the proposed rates are up by more than 10 percent with insurers seeking increases of upwards of 49 percent for some products. Insurers have cited to increases in drug costs and the receipt of more accurate data on their insureds in support of the proposed rates. Between now and October 2015, when the final rates are published, federal and state regulators will …Continue Reading
The Senate’s Permanent Subcommittee on Investigations (PSI) has launched an inquiry into government subsidies under the Affordable Care Act available primarily in the form of advance premium tax credits. According to PSI’s letter to Secretary Burwell, the premium subsidies for last year were approximately $15 billion and are expected to reach $849 billion over the next ten years. Prompting the inquiry are concerns of improper over-payments with the goal of preventing government waste.
According to the letter, “to ensure proper oversight, the U.S. Senate Permanent …Continue Reading
In Malbrough v. Kanawha Insurance Co., 2015 U.S. Dist. LEXIS 48394 (W.D. La. Apr. 9, 2015), the U.S. District Court for the Western District of Louisiana was asked to determine the benefit payable to the plaintiff beneficiaries under an Accidental Death and Dismemberment insurance policy issued by Kanawha. The court held in favor of the insurers, ruling that the beneficiaries were limited to death benefits only, and not to additional benefits relating to the loss of the decedent’s foot.
Following the death of the …Continue Reading
U.S. v. France
U.S. Ct. Apps., Seventh Cir., Apr. 7, 2015
The Seventh Circuit ruled that the federal government has the power to garnish monthly payments from a private disability insurance policy belonging to a dentist that had been ordered, as part of his guilty plea to mail fraud, to pay restitution to victims for a fraudulent billing scheme.
Here, the dentist was ordered to pay $800,000 in restitution to the victims of his fraudulent billing scheme in 2002. However, in 2014, he had paid …Continue Reading
The recent $1.3 million dollar settlement between Midland National Life Insurance Company (“Midland”) and the California Insurance Department – based upon Midland’s inappropriate sales practices in marketing annuities to seniors – is a strong indication that life insurance companies may need to re-examine the various regulations that were issued over the last several years related to annuity suitability. The Midland settlement came after a market conduct examination revealed that the company’s agents had engaged in improper sales and replacement transactions, particularly with senior citizens. In …Continue Reading
George v. Reliance Std. Life Ins. Co.
5th Cir., Jan. 15, 2015
In the appeal of an ERISA disability benefits denial, the Fifth Circuit found an abuse of discretion where the insurer failed to consider the “similar income” provision. The insurer had found in its investigation that the claimant was not totally disabled under the policy as there were sedentary jobs for which the insured was able to perform. What the court found lacking, was any discussion of whether the sedentary jobs the insurer found …Continue Reading
The Patient Protection and Affordable Care Act (PPACA) requires the GAO to study competition and market concentration in the health insurance market. This study examined the individual, small group, and large group health insurance markets prior to the implementation of key PPACA provisions that went into effect in 2014 and that could have an effect on competition and market concentration among health insurers.
The study found that while several insurers participated in each state’s individual, small group, and large group health insurance markets in 2013, …Continue Reading
In an unpublished opinion, the Fifth Circuit affirmed the dismissal of a class action suit that alleged the claim administrator, wrongfully denied payment of medical claims “immediately,” instead of waiting for the participant to fail to provide requested information. In this case, the plaintiff’s son was in an auto accident, and the administrator requested information regarding no-fault benefits before processing the medical claim. The self-funded plan at issue contained detailed provisions regarding Coordination of Benefits, primacy of coverage and information and records the insured is …Continue Reading
In Chanthavong v. Union Security Ins. Co., (11/04/2014), the deceased, Corey Carter, was found in April of 2012, having accidentally drowned in his bathtub. Carter held a group life insurance policy established by his employer through defendant insurer that was subject to the provisions off the Employment Retirement Income Security Act. Carter named his son D.D.C., minor-plaintiff, the beneficiary on the policy. The defendant paid the general life insurance policy in full, but denied the claim under the accidental death policy, claiming the death was …Continue Reading
With 2014 wrapping up, attention is quickly turning to the benefits enrollment period for 2015 including enrollment for health insurance. A new survey out by Towers Watson, the National Business Group on Health, and PriceWaterhouseCoopers provides a glimpse into how employers are thinking about these benefits. One conclusion is that, for health insurance, higher deductible plans are the new black.
Since the passage of the Affordable Care Act (ACA), one of the big questions is what, if any, impact its passage would have on employer-provided …Continue Reading