Health Insurance Carrier Caught Red-Handed

Congratulations to Patsy Bates of Los Angeles, California, who just was awarded a $9 Million arbitration award by an arbitration panel against HealthNet, her health insurance carrier, for it’s illegal cancellation of her coverage at the beginning of her treatment for breast cancer. The award came a day after the Los Angeles city attorney sued Health Net, claiming it illegally canceled the coverage of about 1,600 patients. City Attorney Rocky Delgadillo also said the company illegally ran an incentive program in which it paid bonuses to an administrator for meeting targets of policy cancelations. Health Net acknowledged that such a program existed in 2002 and 2003 but was subsequently scrapped.

This is a clear example of the callousness, and sometimes outright illegality, of the way in which insurance carriers attempt to avoid payment of legitimate insurace claims. Only this time, HealthNet got caught. This was an unusual situation because, apparently, there was an arbitration clause in the health insurance policy that allowed for pain and suffering damages. Most issues regarding payment of claims by a health insurance carrier are preempted by ERISA, and the injured policyholder is unable to sue in court to assert his or her rights under the policy.

Can we presume insurance carriers right here in Georgia are doing the same thing, i.e., cancelling a policy to avoid paying out on a legitimate claim? Yes, probably, they are. The little guy who is injured must continue fight the denial decision, and often at a time in that person’s life when he or she needs to be focusing on another fight, like one against breast cancer, as Ms. Bates did. Fortunately, we have Georgia trial lawyers, like me, ready to take on that fight!

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