Health Insurance

Pre-Existing Condition And Health Insurance

May 31, 2014 | Mark S. Humphreys

Fort Worth insurance attorneys will get calls from people who have been denied benefits by their insurance company because the insurance company claims the person has a pre-existing condition. KSAT recently posted an article about this practice. Here is what the article tells us.

The KSAT 12 Defenders uncovered a little-known fact that insurance companies consider a person’s weight when awarding settlement monies for accident claims.

Maria Vasquez was in a wreck caused by the other driver in May 2013 and found out State Farm is considering her weight while deciding how much to award her in damages.

Failure To Pay Claim And Bad Faith

April 10, 2014 | Mark S. Humphreys

Most insurance lawyers can tell a new client that the fact an insurance company refuses to pay a claim it should have paid does not make the insurance company liable for a bad faith insurance claim. The 1998, Texas Supreme Court case, Provident American Inc. v. Castanden, helps explain this.

Denise Castaneda sought damages from Provident for alleged violations of the Insurance Code and the Deceptive Trade Practices Act arising out of the denial of her claim for benefits under a health insurance policy and the manner in which her claim was handled. Because the evidence was legally insufficient to support the jury’s verdict, this court reversed and rendered judgment that Castaneda take nothing.

Denise Castaneda’s father, Guillermo Castaneda, Sr., applied for medical insurance with Provident in May 1991. He sought a policy that would cover the entire family including his daughter Denise, who was twenty-one years old at the time, her sister, and their brother Guillermo, Jr. During the application process, Guillermo Castaneda, Sr. failed to disclose that just two days before he applied for the policy, Guillermo, Jr. had received medical attention from a physician for jaundice, anemia, and suspected hepatitis. Denise had received medical treatment for jaundice and hepatitis several years prior to the date her father applied for health insurance.

Texas High-Risk Pool Ending

December 10, 2013 | Mark S. Humphreys

Aledo insurance attorneys need to know what is happening in the world of insurance news and events. The Texas Tribune published an article October 17, 2013, that would be of interest to at least 23,000 people in Texas. The article is titled, “Texas Prepares to Shutter High-Risk Insurance Pool.” It is written by David Maly.

Here is what the article tells us:

At year’s end, Texas will shut down its high-risk insurance pool for some of the state’s sickest residents, pushing participants to find private coverage in the federal health insurance marketplace created under the federal Affordable Care Act. And patient advocates say those participants should focus on making the transition sooner rather than later to ensure that they don’t experience a lapse in coverage or lose access to current health care providers and services.

Representations In Insurance Application

January 22, 2013 | Mark S. Humphreys

Fort Worth insurance attorneys and those in Benbrook, Burleson, Lake Worth, and other parts of Tarrant County need to know the effect of the representations made in an insurance application.

There is an important distinction between statements by the insured that are considered to be representations and those considered to be conditions precedent. If the insured’s statement is considered a representation, a false statement alone will not let the insurance company avoid coverage. In contrast, if the insured’s statement is considered a condition precedent, then falsity alone will allow the insurance company to void coverage.

This representation-versus-warranty dichotomy is well developed under Texas law. If the statements are representations, then to avoid liability under the policy the insurance company must plead and prove:

Insurance Coverage – Do You Have It?

August 11, 2011 | Mark S. Humphreys

Residents of Grand Prairie, Arlington, Fort Worth, Dallas, Irving, Richardson, Hurst, Euless, Bedford, Grapevine, Mansfield, and other places all over the metroplex area of North Texas may wonder if the insurance coverage they have bought for themselves is good. Or is the insurance company going to find a reason to not honor their end of the bargain. The following case is an example of how these cases get examined.

The case is styled, Provident American Insurance Company v. Denise Castaneda. The opinion was issued in 1998, by the Texas Supreme Court. Here is some background information.

Denise Castaneda’s father, Guillermo, applied for medical insurance with Provident American Insurance Company in May 1991. He sought a policy that would cover the entire family including Denise., who was twenty-one at the time, her sister, and their brother Guillermo, Jr. During the application process, Guillermo failed to disclose that just two days before he applied for the policy, Jr. had received medical attention from a physician for jaundice, anemia, and suspected hepatitis. Denise had received treatment for jaundice and hepatitis several years prior to the date the insurance was applied for.

Insurance Companies Playing Games?

August 8, 2010 | Mark S. Humphreys

An insured in Dallas, Fort Worth, Grand Prairie, Arlington, Colleyville, Burleson, Benbrook, Grapevine, Irving, or anywhere else in Texas probably thinks they pay too much in health insurance rates. Well, the reality is they probably are paying too much.

The above is addressed in a USA Today article published on July 22, 2010. The author is Alison Young and the title of the article is, “Consumer group: Insurers kept surplus while hiking premiums.” The article focused on Blue Cross and Blue Shield health plans because the company covers one in three Americans with private insurance.

The article tells us that non-profit Blue Cross and Blue Shield health plans stockpiled billions of dollars during the past decade, yet continued to hit consumers with double digit premium increases. This was discovered by Consumers Union in an anaylsis of 10 of the plans’ finances.

Insurance Companies And Injuries And Subrogation

July 24, 2010 | Mark S. Humphreys

If someone in Dallas, Fort Worth, Arlington, Grand Prairie, Mansfield, Hurst, Euless, Bedford, Duncanville, or anywhere else in Texas gets involved in an accident and someone besides themselves are at fault, what happens when health insurance pays for the medical bills resulting from the accident? The answer is one you are going to hate. The answer is: It depends.

There are many variables that come into play, some of which have been discussed in previous blogs. Today we are going to discuss what happens when a person’s own personal health insurance company pays for the medical bills incurred as the result of someone else causing injury to you.

Typical health insurance companies are Blue Cross / Blue Shield, Humana, and other names you have heard about and often times this health insurance is provided as a benefit by your employer. The significance of employer provided health insurance is that many times the health insurance provided through employment is a federally regulated plan called Employers Retirement Income Security Act, otherwise known as an ERISA plan.

Cheating Insurance Company

July 22, 2010 | Mark S. Humphreys

Am I paying too much for my insurance? Whether you live in Cedar Hill, Mansfield, Benbrook, Saginaw, Keller, Fort Worth, Dallas, Grand Prairie, Arlington, or some other place in Texas, that would be a question most people would ask at one time or another when thinking about their finances.

For a California woman, the answer to the above question seems to be, yes. She has sued Blue Shield of California, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety net insurance for peole who were sick or jobless.

This was reported by the Los Angeles Times in an article written by Duke Hefland and published on July 8, 2010.

Pre-existing Coverage For Children?

April 2, 2010 | Mark S. Humphreys

Anybody with children in Grand Prairie, Arlington, Mansfield, Fort Worth, Dallas, or out in Weatherford would want to know how the new federal health bill is being interpreted by lawyers and insurance companies. This was the topic of a recent article in The New York Times.

The article is titled “Coverage Now for Sick Children? Check Fine Print.” This article was published on March 28, 2010. This was right after the new federal health care law was signed into law by President Obama.

One selling point for the new law was that pre-existing conditions coverage for children would immediately go into effect. The reality is that it probably does not. The health insurance companies agree that they must cover pre-existing conditions for children already covered by a policy of insurance. That has consistently been the case. But, the health insurers argue that the new law does not require them to write new insurance for a child and it does not guarantee the “availability of coverage” for all until 2014.

Health Insurer Loses In California

March 23, 2010 | Mark S. Humphreys

It would be interesting to see if what happened out west, would happen here in Texas, with a resident of Grand Prairie, Dallas, Arlington, Fort Worth, Mansfield, or Weatherford. It probably depends on your insurer.

The Los Angeles Times ran an article on March 15, 2010, about a health insurer in California. The title of the article is, “Anthem Blue Cross Should Reimburse California Man For Transplant, Jury Says”.

This article tells about a Los Angeles jury finding that Anthem Blue Cross (Anthem) should cover the cost of an out-of-state liver transplant that a California man paid for after Anthem Blue Cross balked at paying. The liver transplant cost $206,000.