Missouri Insurance Lawyer Blog

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." »

People purchase disability insurance to provide financial assistance in the event they become disabled and unable to work for a living. These policies are sometime purchased by an individual but most often they are provided as a benefit by an employer as part of a group plan. These policies are also commonly sold to professionals such as doctors and lawyers. Unfortunately, many legitimate disability claims are unfairly denied by the disability insurance companies, leaving policyholders without the benefits of a policy they have paid for.

If you have suffered a disability because of car crash or other tragedy or illness you may be entitled to benefits under your group or individual disability policy. If you insurance company denies your claim the law firm of Tatlow, Gump, Faiella & Wheelan may be able to help. To learn more visit our web site or give us a call at 1-800-264-3455.

When an insurance company fails to express itself clearly its policy can be construed against it based upon an ambiguity. In Missouri ambiguity has been described as language which is fairly susceptible of more than one interpretation. It arises where there is duplicity, indistinctness or uncertainty in the meaning of the words appearing in the insurance contract. In other words an ambiguity is an expression in the contract, that when applied to a specific fact situation creates an uncertainty as to whether coverage does or does not exists based upon the agreement itself.
Ambiguity is only one possible theory to defeat an insurance companies denial of coverage. Anyone who has received an insurance coverage denial should consult with a Missouri attorney experienced in insurance law.

A good read from the New York Times.

Personal Health - Patient Advocates Help to Manage Care - NYTimes.com.

In this post I continue on with tips on home owners insurance. Make sure that your home owner's policy is a "replacement costs" policy.
Most policies sold cover replacement costs for structural damage, but it is wise to make sure that your policy is a replacement cost policy. A replacement cost policy pays for the repairs or replacement of damaged property with materials of similar kind and quality. The insurance company will not deduct or depreciate when rebuilding your home. Depreciation is the decrease in value due to the passage of time, wear and tear and other factors. If you have an older home, you may not be able to buy a replacement cost policy. Instead, you may have a modified replacement cost policy. This means that instead of repairing or replacing future typical older homes, such as lathe and plaster walls, solid wood doors, the policy will pay for repairs using the standard building materials and construction techniques in use today. If you have an older home and you want your home to be built back as it was, you should check carefully to insure that this is the way the policy reads. Most likely, you will need to purchase an additional rider or have additional language to your policy to insure a home built with older construction techniques.
Consider buying a guaranteed replacement cost policy. Guaranteed replacement cost policies will pay for whatever it costs to rebuild your home as it was before it was destroyed, even if it exceeds the policy limits. This gives the insured the protection against sudden increases in cost due to shortage of building materials, or booming real estate markets.
Insure that your home is not in a flood zone. Standard home owners insurance does not include flood insurance. Many people who were not within the typical 100 year flood plain but above have recently suffered damage to their homes because of flood waters far beyond those normally expected. You should contact the Federal Insurance Administration at 800-638-6620 to inquire about the National Flood Insurance Program offered through the government.
Make sure that you keep lists of all your personal possessions. Making lists of your personal possessions of everything you own in your home will assist you in making a claim should your home and possessions be destroyed. It is time consuming to make a paper list of everything, and some people choose to use cameras or video recorders to record the items in their home. The manner in which you record all your possessions is up to you, however, a written list along with photographs of more expensive items would be the best practice. Also, be aware that many items such as computers and jewelry have limits on the homeowner's policy. So for instance if you have a lot of expensive computer equipment, you should insure that your policy actually covers them. You may need to buy a personal articles endorsement to cover items above and beyond the limited amount of protection offered in your homeowner's policy. Very few policies have unlimited personal possession limits when it comes to expensive items such as electronics, jewelry and clothing.
There are two basic ways to insure your personal possessions. Replacement cost or actual cost value. A replacement cost policy pays the dollar amount needed to replace a damaged item with one of similar kind and quality without deductions or depreciation. An actual cash value policy pays the amount needed to replace the item minus depreciation. Suppose for example a tree fell through the roof and destroyed your refrigerator. At the time the refrigerator was destroyed it was five years old, but was in good condition. If you had a replacement cost policy for the contents of your home, the insurance company would pay to replace the old machine with a new one of similar type and quality. If you had an actual cash value policy, the company would only pay a percentage of the cost of a new refrigerator because a refrigerator that has been used would be worth less than its original cost. This means that you would either have to pay for the difference between the amount of the actual cash value and what it would cost to buy a new refrigerator or you would have to buy a used appliance.
Consider all of these factors in assessing in your present homeowners insurance or when buying a new homeowner's policy to insure that you are adequately protected.

Every contract has an implied covenant or promise of good faith and fair dealing. Insurance policies are merely contracts between the insurance company and the person who purchased the insurance and people who qualify for insurance benefits under the terms of the contract. Thus, every insurance policy in the United States has a promise imposed by law upon an insurance company to act fairly towards its policy holder and the beneficiaries in the performance of the contract. This is true whether or not such a clause is specifically include in the policy, because courts will read such covenant into the policy as a matter of contract law.
Insurance carriers must therefore meet the objective reasonable expectations of the policy holders and insurers must give equal consideration to the financial interest of its insurer as it does its own interest. Thus, when an insurance company does not have to put its interests behind that of its insured, it cannot protect itself while abandoning its policy holder.

In cases, commonly referred to as bad faith cases, the essential question is whether or not the insurance carrier met its duty of good faith and fair dealing in the situation presented by the performance of its contract obligations. Examples of bad faith include delaying payments, paying less than what is owned, denying benefits or coverage, or failing to settle claims within the policy limits. The insurance companies also have obligations imposed upon them including the duty to promptly investigate all claims, and where appropriate to defend their insured under the terms of the policy. Bad faith action insurance companies policies, practices, and customs will be at issue to show how the insurance company acted, to show its motive, intent, plan and knowledge concerning the particular facts of the case. It is not necessary to show that a insurer acted intentionally to cause harm. Bad faith is a state of mind and may be evidenced by both acts and circumstances on the part of the insurer, but amounts to more than a mistake.
Specific facts that may indicate bad faith on the part of the insurer include demand that the insurer contribute to the settlement, ignoring settlement advice, not disclosing policy limits to a claimant, failing to foresee probable excess verdicts, taking and employing hard line settlement tactics, and properly investigating a claim and properly evaluation a claim, failing to litigate a claim, failing to provide a proper defense, failing to consider settlement, ignoring setting advice, failing to communicate with the insured about the case, or failing to advice the insured about the potential of excess judgments, failing to advise the insured about the policy coverage, failing to advise the insured about existence of settlement offers, acting on behalf of one insured to the detriment of another insured.

It is clear that when people buy an insurance policy that they are seeking protection from the risks insured. If the insurer fails to satisfy their obligations to the policy holder, the policy holder will face the financial risks for which they had purchased protection, as well as the emotional distress as a result of the breach of the policy agreement. Policy holders and beneficiaries are obviously in a vulnerable position when they must rely on their insurance carrier to protect their interest, particularly if the insurance company does not share information, or take appropriate actions to protect the insured's interests, because an insurance company generally has superior knowledge concerning the facts and law, and in all cases where the insured is the wrongdoer, the insurance company is in control of the defense. Therefore, bad faith lawsuits promote not only compensation by injured policy holders and beneficiaries, but provide deterrence from insurance companies acting oppressively towards their customers.

Despite the hundreds of millions of dollars insurance companies spend on advertising to make us believe that insurance comapnies will do the right thing, their actions speak louder than words. So I will be posting stories and verdicts of insurance company fraud, insurance company bad faith, unfair claims denials so that personal injury victims, and consumers can check the fact from the fiction.
For a start read about Allstate's Bad Faith, or about HMO claims denials.