California Insurance Litigation Blog

California Insurance Litigation Blog

Category Archives: Health Insurance

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CBS’ 60 Minutes Segment “Denied” Highlights Insurers’ Wrongful Denial of Mental Health Claims

Posted in Health Insurance, Insurance Commissioner
On Sunday December 14, 2014, CBS’ 60 Minutes program contained a segment entitled “Denied” which highlights that insurers routinely deny, based on lack of medical necessity, treatment for patients with mental illnesses, especially those for long-term in-patient care at mental health facilities.  This segment was an indictment of health insurance companies’ actions (especially Anthem Blue … Continue Reading

Recent Federal Cases Applying the State and Federal Mental Health Parity Acts: What Do They All Mean?

Posted in Case Updates, Class Actions, Health Insurance, Legislation
The Federal Mental Health Parity and Addiction Equity Act (“MH Parity Act”) requires, at a minimum, that the financial requirements and treatment limitations for mental health benefits set by group health plans and health insurance carriers be no more restrictive than those provided for non-mental health medical benefits.  The MH Parity Act was originally signed … Continue Reading

Third-Party ERISA Administrator Abused Discretion by Denying Medical Coverage: A Tale of What Not to Do

Posted in Abuse of Discretion, Administrative Record, Conflict of Interest, ERISA, Fiduciary Duty, Health Insurance, Standard of Review
Sometimes an administrator so unashamedly abuses its discretion in handling an insurance claim that its actions constitute a textbook example of “what not to do” for other administrators and the ensuing decision provides a clear illustration of how courts apply an abuse of discretion standard of review under the Employee Retirement Income Security Act (“ERISA”).  … Continue Reading

Ninth Circuit Emphasizes Need for an Insurer to Have a Meaningful Dialogue With the Claimant When Denying Benefits

Posted in Abuse of Discretion, ERISA, Health Insurance
A recent Ninth Circuit Court of Appeals decision reaffirmed the need for plan administrators to state the reasoning behind their denial of coverage.  In Lukas v. United Behavioral Health,  __ F.3d __, 2013 U.S. App. LEXIS 1230 (9th Cir. Jan. 17, 2013) the Ninth Circuit was faced with evaluating whether the district court properly weighed … Continue Reading

Court Approval is Not Needed to Assert a Punitive Damages Claim Against a Health Care Service Plan

Posted in Case Updates, Health Insurance, Punitive Damages
In a victory for health insurance policy holders over health insurers/health care service plans, in Kaiser Foundation Health Plan, Inc, v. Superior Court (Rahm, et al, Real Parties), 2012 Cal. App. LEXIS 138 (Cal. App. 2d Dist. Feb. 15, 2012), the Court of Appeals ruled that a plaintiff does not need to obtain approval from … Continue Reading

McKennon Law Group Founding Partner Robert McKennon Featured in January 2012 Issue of Forbes Magazine

Posted in Disability Insurance, Health Insurance, Life Insurance, News, Super Lawyer
Los Angeles – Noted Southern California insurance and business litigator Robert J. McKennon was featured in the “Southern California Legal Profiles” section of the January 2012 issue of Forbes Magazine in an article highlighting his experience as a top Southern California insurance and business litigation attorney… Continue Reading

Cause of Action Asserted Against Blue Cross for Violation of Montana’s Unfair Trade Practices Act is Not Preempted by ERISA

Posted in ERISA, Health Insurance, Preemption, Unfair Business Practices/Unfair Competition
In a recent decision, the Ninth Circuit Court of Appeals ruled that ERISA does not preempt causes of action based on unfair insurance practice claims brought under Montana’s Unfair Trade Practices Act.  However, the Court did find that Montana’s so-called “little HIPAA” was preempted by federal HIPAA, which is part of ERISA.  In Fossen v. … Continue Reading

Ninth Circuit Rules that California’s Mental Parity Act Requires Health Insurers to Pay for Certain “Medically Necessary” Treatment for Mental Illnesses

Posted in Abuse of Discretion, Case Updates, ERISA, Health Insurance
In an important decision, the Ninth Circuit Court of Appeals ruled that California’s Mental Health Parity Act (“Parity Act” ) requires that health insurers cover certain medically necessary treatment for certain mental illnesses, even if the insurance policy explicitly excludes such coverage.  In Harlick v. Blue Shield of Calif., __ F.3d __ (9th Cir.  August … Continue Reading

California Courts Deal Another Blow To Plaintiffs’ Efforts To Bring Class Actions Based on Insurer and Agents Misrepresentations

Posted in Class Actions, Health Insurance, Life Insurance
The California Court of Appeals for the Second District has upheld a trial court finding that may effectively limit and discourage attorneys from filing class actions based on misrepresentations in the sale of insurance policies through agents.  In Fairbanks et al. v. Farmers New World Life Ins. Co. et al., __ Cal. App. 3d __ … Continue Reading

Insurance Commissioner Jones Charges that Blue Shield Improperly Denied Health Insurance Coverage for Necessary Autism Treatment

Posted in Health Insurance, Insurance Commissioner
California Insurance Commissioner Dave Jones recently announced that the California Department of Insurance is investigating whether Blue Shield of California Life and Health Insurance Company (“Blue Shield”) failed to comply with the California Mental Health Parity Act.  Specifically, Blue Shield is required to respond to an Order to Show Cause regarding its handling of claims … Continue Reading

Court of Appeals Rejects Blue Shield’s Attempt to Impose a Two-Year Statute of Limitations for Bad Faith

Posted in Class Actions, Health Insurance, Insurance Bad Faith
Myrna Kawakita was set to undergo gastric bypass surgery, and her health insurer, Blue Shield of California, initially authorized the procedure.  However, rather than paying for the procedure, Blue Shield rescinded Kawakita’s health insurance policy, asserting that her application contained misrepresentations about her height and weight. Kawakita purchased her health insurance policy through Blue Shield’s … Continue Reading

Nurses’ Association Study Shows That California Insurers Denied 26 Percent of All Health Insurance Claims in 2010

Posted in Health Insurance, News
Despite more attention focused on the nation’s largest health insurance companies with their recent requests for large premium increases and with all of the talk about national healthcare reform, California’s largest health insurance companies continue to deny about 26 percent of all health insurance claims, according to a recently released study by the California Nurses … Continue Reading

California’s Largest Health Insurers are Fined by California Department of Managed Health Care for Inadequate Claims Practices

Posted in Health Insurance, Legislation, News
In today’s Los Angeles Times Business Section, Duke Helfand writes about an 18-month investigation by the California Department of Managed Health Care into the payment practices of Aetna Inc., Anthem Blue Cross of California, Blue Shield of California, Cigna Corp., Health Net Inc., Kaiser Foundation Health Plan and United Healthcare/PacifiCare. … Continue Reading

Commissioner Poizner Releases Results of His Second Preferred Provider Organization Quality of Care Report Card (And it is Not Good)

Posted in Health Insurance, News
Last week, Commissioner Poizner released the results of his second Preferred Provider Organization (“PPO”) quality of care report card. The results are not good news for consumers, and show that California’s PPOs have much work to do in meeting customer needs. According to Poizner: “California PPOs rank in the middle of the pack compared with … Continue Reading

Court of Appeal Holds that Insurance Companies Are Not Required to Disclose the Lowest Premium They Would Accept But Reaffirms Insurers’ Duty to Disclose Material Facts as to Coverage

Posted in Case Updates, Health Insurance
Understanding modern day insurance contracts is no easy task, even for experienced attorneys.  The wording is dense and the language is often archaic and hard to comprehend.  As a result, consumers often rely on their insurance company to help them navigate the multitude of different policy types, structures, pricing and provisions.  Recently, the California Court … Continue Reading

Certain Health Insurance Reforms Go Into Effect as of September 23

Posted in Health Insurance, Insurance Commissioner, Legislation
On September 23, 2010, the Patient Protection and Affordable Care Act, part of the recently enacted health care reform law, went into effect for insurance plans that begin on or after this date.  Health care reforms beginning Sept. 23, 2010 include: No pre-existing condition exclusions for children under age 19: requires insurers to cover children … Continue Reading

New Appeal Regulations For Health Plans Require Final Claims Decision To Be Made By External Reviewer

Posted in ERISA, Health Insurance, Legislation, News
The Department of Health and Human Services issued new appeal regulations under the recently enacted Patient Protection and Affordable Care Act (“Affordable Care Act”).  These regulations give claimants the right to appeal decisions made by their health plan to an outside, independent decision maker, regardless of what state they live in or what type of … Continue Reading

Insurance Commissioner Announces Examination of Anthem’s Claims-Related Data

Posted in Health Insurance, News
Insurance Commissioner Steve Poizner announced last week that his office will conduct an examination of Anthem Blue Cross’s claims-related data used by Anthem to justify its future rate filings. This comes after Anthem’s decision to withdraw its recent application to increase rates to thousands of insureds in California.  Here is the press release: NEWS RELEASE … Continue Reading

Two Major California Health Insurers to Cease Practice of Policy Rescissions

Posted in Health Insurance, News
For several years, health insurers have been strongly criticized for engaging in post claim underwriting and improper policy cancellations, known in the law as “rescissions.”  The Insurance Commissioner has even recently regulated the practice. Now, after this significant criticism and facing tougher federal regulation, two of California’s largest health insurers say they will stop rescinding … Continue Reading

California Appellate Court Allows State Law Claims Against Private Medicare Plans

Posted in Case Updates, Health Insurance, News
In a case of first impression, the Fourth District Court of Appeal opened the door to new lawsuits against private Medicare plans that had previously been held to be preempted by the federal Medicare Act. In Cotton v. Starcare Medical Group Inc., __ Cal.Rptr.3d __, 2010 (Cal. App. 4 Dist.), the court found patients who are … Continue Reading

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act Summary and Implementation Timelines

Posted in Health Insurance, Legal Articles, Legislation, News
Eric M. Peterson from the law firm of Dorsey & Whitney LLP has done a nice job summarizing the recently enacted Patient Protection and Affordable Care Act.  Peterson’s article, ‘Health Care Reform is Here’ is set forth verbatim immediately below, followed by the Democratic Policy Committee‘s implementation timeline for both Acts. Health Reform and Reconciliation … Continue Reading

California Supreme Court Accepts Review of Howell: Will the Collateral Source Rule Be Extended to Cover Non-Discounted Medical Expenses?

Posted in Case Updates, Health Insurance, News
The collateral source rule is familiar to every attorney in California.  Every attorney recalls spending time studying the rule in law school.  The collateral source rule is critical to people injured by the wrongful conduct of tortfeasors, whether they be an individual involved in an auto accident or multinational corporations committing mass torts. The collateral … Continue Reading

California Insurance Commissioner Says Anthem Blue Cross Violated California Law More Than 700 Times

Posted in Health Insurance, Legislation, News
Just when you thought the bad news for Anthem Blue Cross (“Anthem”) could not get any worse, it does.  According to an article by Duke Helfand appearing in today’s Los Angeles Times, California Insurance Commissioner Steve Poizner reported that Anthem, California’s largest for-profit health insurer, violated California law more than 700 times over a three-year period by … Continue Reading