The basic premise behind the Affordable Care Act is to reduce the overall cost of healthcare. The law precludes insurance carriers from denying coverage for preexisting conditions and it also allows younger individuals to remain on their parent’s health insurance plans until they reach the age of 26.
The Florida Supreme Court handed down three decisions settling insurance disputes on July 3, 2013. The cases were very different: One dealt with a reimbursement issue, another with an automatic benefit increase and the last with replacement cost coverage. In our last two posts, we reviewed the first two decisions. Here, we will tackle the third.
We are continuing our discussion of three Florida Supreme Court decisions handed down earlier this month. As we said in our last post, insurance companies did not prevail in any of the cases.
Insurance companies did not fare well in three recent Florida Supreme Court decisions. Two cases sprang from policyholder complaints, while the third involved a medical provider. If policyholders — be they individuals or businesses — take one thing away from these decisions, it should be to read every policy carefully.
We are discussing a recent U.S. Supreme Court decision regarding the proceeds from a life insurance policy. The insured was covered under the Federal Employees’ Group Life Insurance plan, and when he passed away in 2008 his widow discovered that the named beneficiary on the policy was his ex-wife. The insurer distributed the proceeds to the ex-wife, and the widow sued.
This is not a typical insurance claim story. The insurance company, in fact, barely makes an appearance. Nor is it a story about Florida. What it is is a story about the power of the insurance contract.
To some, particularly citizens in the state of Florida, the Affordable Care Act seems to be working. Federal officials have mandated various insurance companies provide health insurance rebates to insured individuals-millions of dollars in fact. But why?
We all know that the insurance industry is highly regulated. States exercise a good deal of control over what insurance companies charge (rates and premiums) and how they manage their finances to make sure they have enough money set aside (reserved) to pay the claims they are obligated to pay their policyholders.
A little more than a year ago, the Florida Office of Insurance Regulation issued an order allowing commercial property insurance companies to use new forms without first obtaining the OIR’s approval. The “fast-track” process will become state law on July 1.
We are finishing up our discussion of anti-concurrent causation clauses, but we would like to reserve the right to revisit the issue. A state that was hit hard by Superstorm Sandy is considering legislation that would address, among other things, anti-concurrent causation clauses in homeowners insurance policies. The insurance industry calls the proposal “misguided, if well-intentioned.”
