Medicare enrollment is currently open through December 31st. If you want to apply for Medicare benefits for yourself or help a loved one apply but don't know where to start, call the Missouri Department of Insurance or visit their website. They're offering free assistance to anyone who needs help with the enrollment process via the CLAIM Insurance Assistance project. You can also visit the CLAIM website for more information.
Many people assume that they don't need insurance if they don't own the building or house in which they live. But you should know that if you rent an apartment or home, your possessions are typically not covered by the building or home owner's insurance purchased by your landlord.
Most renter's insurance policies cover things like fire, theft, vandalism and other events that could damage your personal belongings. Like home owner's insurance, however, renter's insurance typically does not cover some natural disasters such as floods and earthquakes. It is important to read your renter's insurance policy carefully to determine what type of coverage you have.
It was reported on Tuesday, September 21st by the Missouri Department of Insurance that eight companies and individuals have been accused of selling fake health plans. The fines against these companies and individuals is more than one million dollars.
The companies sold plans that were disguised as medical insurance. The plans were marketed through unsolicited faxes which at least 150 Missouri Consumers bought. The faxes said things such as "Dependent Coverage" and "Group Health Plan."
$130,000 in fines were imposed by regulators. Cease and desist orders were also issued for the following individuals and buisnesses:Thomas J. Sullivan; Richard Bachman; James M. Doyle; Bart S. Posey Sr.; Christopher Ashiotes; and Obed Kirkpatrick; Smart Data Solutions; Affinity Group Benefits Association Inc. Discount- plan marketers caught violating the court orders will likely face criminal prosecution.
Individuals who have been cheated by insurance companies have the right to sue the insurance company for damages. Government agencies police business but don't get compensation for the damages the consumer suffered. If an insurance company cheated you, you should speak to an experienced attorney about your legal rights
All 50 states have been affected by a Tennessee based entity called the American Trade Association (ATA) plus other affiliated firms, which was selling fake health insurance. The program was supposed to work by the ATA taking out money directly from consumer's accounts. Consumer's thought they were saving hundreds of dollars each month on premiums until an issue with their health came up and they found out they were not insured.
Some consumer's have shared their stories through Smart Data Solutions where one person stated, "I tried to get prescriptions through my card and it is not covered. They say they are getting a new plan, but did not inform anyone. Their phone goes unanswered, or it is busy. Their website; http://www.myatabenefits.com doesn't work either. This is either an incredibly poor run organization, or a scam."
After investigations were held consumers found out that their money had actually been used to pay for personal items such as cars, real estate, and loan payments. Some claims were paid, but only the small ones to maintain the appearance of legitimacy.
The state of Maine actually ordered the American Trade Association to pay a $1.2 million penalty because of the unlicensed products sold to consumers, the unlicensed agents, and for not adequately paying for consumer's medical bills.
Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services describes how this is just the beginning. There will be more scammers out there because they know people are seeking cheaper insurance coverage.
Consumers who want to research a company can check with their State Department of Insurance. If you are scammed by insurance company or a company that promises to provide insurance and does not, you have legal rights. In Missouri an insurance company that does not honor its promise can be sued for breach of contract and in some circumstances for bad faith. If a company poses as an insurance company but is a fake, you can sue for damages for breach of contract, misrepresentation and fraud. If you have been scammed you should also report the company responsible to law enforcement.
Continue reading "Health Insurance Scam Affects 26,000 People Across the U.S." »
In a case handed down August 6, 2010 by the Missouri Court of Appeals, Southern District, the court found that the proposed lien of a health insurer was an invalid attempt to require assignment of the Participant's personal injury claim and, as such, it was contrary to longstanding Missouri public policy. Scroggins v. Red Lobster, No. SD 30214.
In 2007, Pamela Scroggins was seriously injured in a trip and fall accident at a restaurant. Ms. Scroggins' medical expenses were covered by an employee contributory self-funded health plan that provided benefit coverage to her under her employer provided health care plan. As a result of her injuries, Ms. Scroggins sued the restaurant and the lawsuit resulted in a settlement.
One of the health insurance plan provisions purported to grant the health insurer a lien upon the proceeds of the Participant's tort recovery, and a right to payment from any recovery, to the extent of the sum that the Insurer paid for injuries Ms. Scroggins suffered. This is not unusual. Insurers paying benefits to insureds as a result of injuries caused by third persons often claim an interest in recovering those costs if the insured obtains a settlement or collects upon a judgment against the third party. To that end, insurers have repeatedly attempted to draft policy provisions or establish other requirements for the purposes of seeking reimbursement from the insured in such situations.
Insurance companies doing business in Missouri will soon face tighter oversight thanks to a new law that takes effect on August 28, 2010. The Missouri Department of Insurance explains that the new law will give the state's insurance regulators the power to step in sooner when an insurance company is in enough financial trouble that it may not be able to pay it's customers' claims. To read more about this new law, visit the Missouri Department of Insurance website press release.
On Tuesday, August 3, 2010, in a far-reaching decision, the Missouri Court of Appeals, Western District, handed down Robinson v. Hooker, Case No. WD71207, which applied the 2005 "strict construction" amendment to the Missouri Workers Compensation Act, and allowed lawsuits against negligent co-workers to proceed in civil court. It determined that co-worker liability is no longer protected under the shield of workers compensation.
Prior to 2005, Missouri statute 287.800 mandated that all provisions of the Workers' Compensation Act be liberally construed. Under this standard, courts broadly interpreted the Act to extend benefits to the largest possible class and resolved any doubts as to the right of compensation in favor of the employee.
Life insurance is a critical financial tool for many families in the United States. As a recent Missouri case illustrates, the failure of an insured to give true answers on a life insurance application can result in a loss of the insurance policy when it comes time to collect the life insurance. In the case of Adams v. Stonebridge Life Insurance Company, the 8th Circuit Court of Appeals held that where a man who purchased life insurance policy gave false and misleading answers on application in response to questions regarding whether or not he had a pre-existing mental disorders, the company could rescind the policy. The court noted that the insurance company justifiably relied on the man's application answers and therefore the claim for benefits to the beneficiaries after the applicant's death was proper.
This underscores two important points. First, that the application is very important in the process of obtaining life insurance and will be relied upon by the insurance company in determining whether or not to insure a person, and the amount of premium that will be paid if the application is accepted. Second, while subject to certain statutory limitations, an insurance company generally has the right to rescind the policy when the application answers were falsely made by the applicant. Most states, including Missouri have a non-contestability clause, under which after a certain period of time has passed answers will no longer form the basis for rescission. However, as no one ever knows when they will die, it is important practice to only provide correction information when applying for life insurance, so that the benefit will actually be there when it is needed.
If you're shopping for new insurance coverage, you should investigate the insurance companies you're considering before you decide to buy coverage from them. Missouri has an Insurance Complaint Index that shows you how insurance companies treat their policy holders and handle claims.
Each insurance company is given an index rating. Receiving a 100 is average. If a company receives a number lower than 100, they are below average on receiving complaints. For numbers above 100, they receive more than the average amount of complaints.
The Consumer Affairs Division (CAD) of the Missouri Department of Insurance mediates complaints. In 2009 the CAD returned a record $14 million to consumers who had been unfairly denied claims or overcharged on premiums.
Think about how hard it would be to recreate the contents of your home if you suffered a loss. It would be hard to sit down and think about everything you'd had and make an inventory. Many valuable items might be forgotten. It should be a little easier now. Missouri Department of Insurance Director James M. Huff has created a home inventory checklist to make inventorying your home's contents easier. The checklist is a simple fill in the blank document that you can print out once you're finished. The checklist takes you through one room at a time to insure you don't miss anything. Huff recommends keeping as many receipts of purchases in a fire- proof area. Consumers should update their inventory anytime a new purchase is made.
You can download the checklist at no charge from the Department of Insurance's website or request a hardcopy by mail by calling the Insurance Consumer Hotline at 1 800 726 7390.
The Missouri Department of Insurance recently announced that health insurance companies in Missouri are now required to cover dependant children up through age 26 under a parent's health insurance policy. The requirement takes effect for policy years beginning September 23rd or later. The age 26 requirement does not apply to adult children who have other health insurance available to them, such as through their own employer's policy. Coverage must include all the benefits of younger dependents and at the same price.
Some insurance companies are making this new policy available now including United Health Care, Anthem Blue Cross and Blue Shield, Aetna, Cigna, Blue Cross and Blue Shield of Kansas City, Coventry, and Humana. These companies cover almost 66 percent of licensed health insurance for covered Missourians.
Almost 20,000 more Missouri children will now have health insurance. The new policy will only apply to health insurance plans that offer dependent coverage, though most insurers and employer based plans do offer dependent coverage even though there is no requirement to do so.
You can read more about this new extension of coverage at the Missouri Department of Insurance website.
On July 6, 2010 Missouri Department of Insurance Director James M. Huff announced that $81 million in federal funding will be used on new health coverage for Missourians who have had trouble getting health insurance because of pre-existing conditions.. The idea was proposed by the Missouri Health Insurance Pool (MHIP) and was approved by the federal government. The program will also be funded by premiums that are paid by policy holders and will provide insurance coverage at competitive rates. Eligibility requirements state that you must be a Missouri resident with pre-existing medical conditions, and that you have been uninsured for at least six months. The federal and state high risk pools are available until 2014, then all applicants, regardless of health status, will be offered coverage at market rates because the new federal law will require it.
You can apply online at the MHIP website, or you can call (800)821-2231.
In a 7-0 decision written by Judge Richard B. Teitelman, the Supreme Court of Missouri confirms that an insurance company must promptly investigate a claim and its failure to do so is unreasonable and vexatious. D.R. Sherry Construction, Ltd. V. American Family Mutual Insurance Company, Case No. SC90442.
Sherry, a general contractor engaged in the business of building homes, filed suit against his commercial general liability insurer, American Family Mutual Insurance Company after the insurance company refused to investigate and pay a claim. Sherry made a claim on his insurance policy after a house that he built and sold, incurred structural damages caused by continuous and repeated exposure of the foundation to poor soil conditions.
Subsequent to the sale of the home, the new homeowners contacted Sherry and notified him that the foundation and drywall were cracking. Mr. Sherry inspected the house and confirmed the existence of the cracks. The homeowners threatened a lawsuit against the contractor. Mr. Sherry submitted a claim to his insurer, but American Family advised Sherry that it would not undertake further investigation of the claim until the homeowners actually filed a lawsuit. At that time, Sherry entered into an agreement with the homeowners to repurchase the home.
Sherry then filed this lawsuit against American Family asserting claims of breach of contract and vexatious refusal to pay. American Family claimed that that policy had expired at the time of making the claim, and that they did not owe anything under the policy.
The court found (1) that the damage to the house began during the policy period and was progressive from that point forward, and therefore was covered by the policy at issue; (2) the interpretation of an insurance contract is a question of law to be determined by the judge and only becomes a jury question when the court determines that the contract is ambiguous and there exists a genuine factual issue to be decided by the jury; and (3) American Family's delay and then refusal to investigate the contractor's claim was sufficient basis for concluding that the insurance company unreasonably and vexatiously refused to pay a valid claim for property damage.
The National States Insurance Company of St. Louis has serious financial problems and they have been ordered to go through a state-mandated rehabilitation process.. They will be taken over by Missouri Department of Insurance director James M. Huff. Rehabilitation protects the policyholders by preserving the company's assests. Huff must protect Missouri consumers who have long term care, life and Medicare Supplement insurance coverage with National States.
You can read more about National States on the Missouri Department of Insurance website. Policyholders with questions can also call the Department of Insurance Hotline at (800)726-7390.
Small business owners have to be many things, from salesman to maintenance to human resources and more, to run a successful business. One of the many things small business owner should be well informed on is insurance coverage. The National Association of Insurance Commissioners (NAIC) makes this challenge a little easier by offering a website, Insure U for Small Business, that is full of helpful information designed to make the small business owner's quest for the right insurance coverages a little easier.
The NAIC is the organization of insurance regulators from the fifty states, District of Columbia and U.S. territories.
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