News & Resources

If nothing else, the health care debate has produced some interesting studies. The most recent, released this week, zeroes in on pre-existing conditions. A pre-existing condition is defined as a health condition that exists before a person submits an application for health insurance. In truth, it is one of a list of health problems that require elevated levels of care, either acute or chronic. Insurers are notorious for denying or limiting coverage because of a pre-existing condition — and, of course, because of the costs associated with the condition.

Florida’s state insurance company may suspend coverage for homeowners who have made Chinese drywall claims. According to an attorney representing about 300 claimants, Citizens Property Insurance has started to alert policyholders with the defective building material that their coverage will be dropped.

Citizens Property Insurance, Florida’s state-run insurance company, reports that 200,000 new customers have signed on this year, bringing the total number of insureds to 1.3 million. These customers represent about $457 million in property coverage, or approximately 18 percent of Florida’s total property insurance coverage.

United Nat’l Ins. Co. v. Best Truss Co., No. 09-22897-CIV, 2010 WL 5014012 (S.D. Fla. Dec. 3, 2010)

Florida’s property insurance companies filed for significant rate increases last year, most citing sinkhole claims as their rationale. Homeowners are skeptical that the sinkholes are at the bottom of the issue. The issue made it to the legislature, and the Senate Banking and Insurance Committee released a report this week that is likely to continue, rather than resolve, the controversy.

A questionable, if not illegal, insurance practice came up in a recent Jacksonville case. It started as a straightforward injury claim from a car accident, an admission of fault and a jury award. When the dust settles, it may be a cause célèbre for consumer advocates and insurance attorneys.

The year isn’t over quite yet, but 2010 has already logged a remarkable number of privacy breaches. As of November 30, the Office for Civil Rights of the U.S. Department of Health and Human Services had received reports of 197 health insurance companies, health care providers and health data clearinghouses failing to protect individually identifiable health information as required under HIPAA and HITECH regulations. Nearly half of those reports have been made since July.

Customers of Florida-based AvMed Health Plans have filed a class action lawsuit against the insurance company in connection with a breach of privacy that occurred in December 2009. Seeking unspecified damages, the plaintiffs claim that, in addition to failing to safeguard the private medical data, the company vastly underreported the number of customers affected by the breach.

Late last month, a group of Holocaust survivors’ efforts to have their dispute with an Italian life insurance company heard in court ended in defeat when the U.S. Supreme Court declined to hear their appeal. It was the second time the lead plaintiff had petitioned the Court to appeal his claim. Now it appears that only Congress can act to allow the survivors to sue the insurance company. There they face millions of dollars in insurance company lobbying.

Insurance regulators in Florida could not ignore the recent fines imposed on seven health maintenance organizations in California. The organizations were the targets of that state’s Department of Managed Health Care investigation into complaints from doctors and other health care providers about insurance claim payment practices. The fines totaling $5 million were just part of the decision: The seven HMOs must also pay restitution to the providers, and that could add up to tens of millions of dollars.