Insurance Legal News Articles & Interviews

Washington, DC Dr. Joaquin Lopez ‘s surprise emergency room bill came after he and his insurer had already paid $11,000 toward the cost of emergency gallbladder surgery. For dentist Brad Buckingham, who fell off his bicycle, the shock was a $70,000 bill to repair a broken hip. For Stacey Shapiro, it was a $6,720 emergency room fee to treat sudden spell of low blood sugar.

Scottsdale, AZ: Emergency room care in the US is the highest-priced care a patient can receive. Even a minor condition can set you back thousands of dollars, which in itself can cause health issues—financial problems are stressful. It can get worse: one patient dinged with outrageous emergency room overcharges later discovered that another patient with similar treatment paid a lot less.

San Francisco, CA In one of the earliest decisions of 2019, the Ninth Circuit gave plaintiffs in long term denied disability lawsuits a new way to challenge benefit denial decisions. It may turn out to be significant.

Los Angeles, CA: When a nine-year old accidentally had gasoline splashed in her eyes, her mother immediately drove her to the closest hospital emergency room. They were directed to the eyewash station but it was so dirty they couldn’t use it, so Brianna’s mom rinsed her daughter’s eyes at a regular sink. Turns out, they would have been better off using the gas station’s eyewash, which was free. The ER sink cost $1,400: the hospital charged $600 and the ER doctor fee was $800 (for walking into the room, saying Brianna needed an eyewash station and walking out). Upcoding has become common practice, resulting in emergency room overcharges and increased health costs for everyone.

Santa Ana, CA On November 20, 2018, the U.S. District Court for the Central District of California handed Pamela Fleming a resounding victory in her Unum disability insurance lawsuit. Unum had been paying her LTD benefits since 2005, after a serious and well-documented neck injury sustained in a car accident. A change in her treating physician and a brief surveillance video led the insurer to re-evaluate her claim and declare that she had recovered. The insurer terminated her benefits. Judge Cormac J. Carney was not impressed and reinstated her benefits due under the policy.

Oklahoma City, OK In November 2018, a jury awarded nearly $25.6 million to the family of a Oranna Cunningham, a woman who was diagnosed with advanced nasopharyngeal cancer. Her insurer, Aetna, refused to cover the cost of the proton beam therapy recommended by her physician, claiming that it was “experimental or investigational.” After her death, her husband brought a bad faith insurance lawsuit.

Chicago, IL: Yet another lawsuit was filed in November against First Unum for allegedly denying long-term disability benefits. In the same month, Unum announced to the media that it had donated $300,000 to a high-school girls’ leadership program.

Los Angeles, CA On September 14, 2018 Marisa Finnerty filed a long term denied disability lawsuit against the Life Insurance Company of North America (LINA), alleging that she had been wrongly denied benefits under her employer, Quest Diagnostics’, long term disability and group life insurance plans. Two things stand out about this lawsuit.

New Orleans, LA: The giant insurance company Unum—also known as First Unum -- typically denies accidental death benefits (as do most other life insurance companies) by excluding in their policy coverage for deaths related to prescription overdose or for medical or surgical treatment of a sickness or disease. But Unum’s denial didn’t sway Judge Martin Feldman this past August.

Sacramento, CA: Workers in the U.S. who received psychotherapy through their employers’ plans with United Healthcare Insurance Co. and United Behavioral Health (UBH) in California have filed a proposed class action, claiming the insurers have violated mental health laws