
The high profile and, many believe,
politically-motivated litigation
by a few state Attorneys General (some in
defiance of their own
Governors) to
invalidate the new health insurance reform law is nothing compared to the
litigation that will likely be needed to force insurance companies simply to
comply with the law.
Today we learned
that “insurance companies are already arguing that, at least for now, they do
not have to provide one of the benefits that the president calls a centerpiece
of the law: coverage for certain children with pre-existing conditions” –
conditions like “asthma,
diabetes,
birth defects,
orthopedic problems, leukemia, cystic
fibrosis and sickle cell
disease.” (In other
words, they want things to be business-as-usual, like how they handled 10-day-old Houston Tracy, who needed surgery to correct a
congenital heart defect and whose insurer initially denied the claim calling
the birth defect a “pre-existing condition.”)
The insurers now seem to be saying
that rather than refuse to cover treatment for a pre-existing condition, the
company “might simply deny coverage for the child or the family” until 2014,
when they are required to provide coverage. Whoa. The Times writes,
Senator John D.
Rockefeller IV, Democrat of West Virginia and chairman of the Senate
commerce committee, said: “The ink has not yet dried on the health care
reform bill, and already some deplorable health
insurance companies are trying to duck away from covering children
with pre-existing conditions. This is outrageous.”
The White House says it will try to clarify this through
regulations but “lawyers said the rules could be challenged in court if they
went beyond the law or were inconsistent with it.” Gee, an insurance company forcing a case into court?
Welcome to the world of policyholders and their attorneys,
who spend a good chunk of their life trying to get intransigence insurance
companies to comply with the law and pay legitimate claims - like the Chinese
drywall case that a homeowner recently won in Louisiana. Remember the ongoing, enormous
Chinese drywall mess?
(“Many homeowners in southeastern states such as Louisiana and Florida have
found that drywall imported from China amid the housing boom and rebuilding
efforts after the 2004 and 2005 hurricanes emits sulfuric gases that smell bad,
make people feel sick and corrodes metal appliances, wiring and components in
homes. Insurers have universally been denying claims.”)
In this new case, a local judge ruled that “the policy
exclusions that insurers have commonly been using to deny claims for drywall
damage don’t apply.” For example,
insurers were actually trying to get out of covering a homeowner's claim by applying an "environmental damage"
exclusion, even though clearly the damage to homes came from defective building materials - not pollution. The legislature is also considering a bill to prevent
homeowners who file these claims from being cancelled.
Oh, they’ll need that law.
And they’ll need good trial lawyers, too!