California Insurance Lawyer Blog

Photos on Social Media Sites May Give Insurance Adjustors Wrong Impressions

Canadian citizen Nathalie Blanchard was merely following her doctor’s suggestion that she spend time with friends and vacation in a sunny climate as a cure for depression when her sick-leave benefits from her employer-provided insurance were abruptly terminated. Nathalie made the fatal error of posting photos of herself having fun on Facebook. Her insurer discovered the photos, determined she was no longer depressed and told her to return to work. Although the insurer told the Associated Press that it did not solely rely on the Facebook photos in making its decision, it neglected to mention what other sources – such as sound medical evidence -- it did rely on. Nathalie is appealing the denial. See “Canadian Woman Loses Benefits Over Facebook Photo,” http://news.yahoo.com/s/ap/20091122/ap_on_re_ca/cn_canada_facebook_insurance.

This latest news article illustrates the level of scrutiny ill and injured people typically encounter from their insurers when they are unfortunate enough to actually need the benefits they’ve paid for. Their lives become open books where even the most innocent of activities become an insurance inspector’s evidence of suspected fraud.

Here’s our sad but true advice to Americans receiving disability benefits: What you post or print on social media sites will be discovered by your insurer and interpreted in the light most unfavorable to your disability claim – even if you are only following doctor’s orders.

Long-term care advocate and blogger Howard Gleckman weighs in on the CLASS Act, the federal government’s long-term care proposal included in pending health care legislation, for Kaiser Health News. See “Will People Buy Government Long-Term Care Insurance,”
http://www.kaiserhealthnews.org/Columns/2009/November/111609Gleckman.aspx.

Gleckman predicts that significantly more people will purchase government LTC coverage than those who currently purchase private insurance, but it still won’t be enough to solve the nation’s long-term care challenges. To increase purchasers, Gleckman suggests the following:

First, make coverage mandatory and require all major employers to offer it. If employees are allowed to opt out, impose tough penalties on both employers and workers who don’t participate.

Second, do more to encourage young employees to buy coverage. Determine premium amounts by age at enrollment and never increase (or only moderately increase) premiums, while providing more benefits as policyholders age. That way, workers would enroll while they are young and healthy to avoid costly premiums when they need coverage.

Third, the government could give employers financial incentives to match worker contributions.

Let's see what, if anything, the ultimate health care bill will contain on the Long Term Care question.

Federal Healthcare Legislation Could Erode California’s Consumer Protections

Lisa Girion of the Los Angeles Times reports that a provision of federal healthcare legislation under consideration could harm consumer protections in states that have strong laws that both protect policyholders’ rights to insurance coverage for certain health treatments and the ability to appeal coverage denials. “State Health Laws at Risk,” Los Angeles Times, November 16, 2009. http://www.latimes.com/business/la-fi-mandates16-2009nov16,0,2437457.story. Healthcare overhaul bills in both houses allow insurers from other states to sell insurance in California without being subject to the state’s tougher enforcement mechanisms.

“California mandates require insurers to cover home healthcare, bone density screening for osteoporosis, in vitro fertilization and mastectomy. Mandates also cover certain providers, such as chiropractors, and conditions, such as autism. If insurers are allowed to sell under the laws of other states, they might be able to offer policies that do not include those benefits,” Girion writes.

Other California protections potentially at risk include prompt claims payment laws. In California, a policyholder has the right to appeal an insurer’s refusal to pay for a particular treatment. Other states may not offer the same protections.

Proposed federal healthcare legislation remains controversial. While on one hand it offers more competition and lower premiums for California consumers, on the other hand it could undermine gains consumers have achieved in California.

It’s always a good idea to read a policy before purchasing any kind of insurance. If something seems questionable or you don’t understand certain provisions, ask for explanations and help. Don’t sign any policy until you are convinced you will get what you pay for or are afforded the right to appeal when you don’t.