Business
Insurer accused of unfair claims denial
NEWS IN BRIEF — Posted Feb. 12, 2007
The Connecticut Insurance Dept. is investigating Milwaukee, Wis.-based Assurant Health over accusations it unfairly denied claims.
At least 20 complaints have been lodged with the attorney general's office over the past few years regarding Assurant denying claims related to individual policies. Connecticut Attorney General Richard Blumenthal said he is proposing legislation that would ban insurers from checking into a customer's medical background after issuing a policy for the purpose of finding reasons to deny claims.
Connecticut allows insurers to deny claims for preexisting conditions, but only in certain circumstances. For a 12-month policy, the insurer can deny claims during the first 12 months of the policy stemming from problems that existed 12 months prior to the policy's start date.
Assurant says the denials stem from medical problems that patients should have disclosed when they applied for the policies.
The Hartford Courant reported the Connecticut Insurance Dept. has recovered $24,478 from Assurant for claims it found to have been improperly denied. The department is currently looking into five years' worth of claims and underwriting data.
The issue of insurers denying claims to individual policyholders has popped up lately in other states, most notably California. The California Medical Assn. is joining a class-action lawsuit against Blue Cross of California, accusing the plan of digging through records to try to find ways to rescind claims involving certain individual policyholders. Blue Cross says it has followed state law and has denied wrongdoing.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/02/12/bibf0212.htm.
