California Insurance Lawyer Blog

Insurance Commissioner Dave Jones recently announced that the California Department of Insurance is implementing new regulations to protect California home owners from being underinsured in the event of a disaster. These regulations target the homeowners insurance industry, and have been established to ensure that consumers who are victims of a disaster, such as an earthquake or wildfire, will be able to get the necessary financial relief to rebuild their homes. The regulations have been formulated to address the common problem of underinsurance that many homeowners face.

The new regulations include provisions:
- requiring insurers to create more consistent, comprehensive and accurate replacement cost calculations;
- requiring insurers to establish clear training standards for agents and brokers who sell homeowner’s insurance;
- creating standards for real estate appraisers who estimate replacement cost for insurance purposes;
- requiring the application of certain standards when estimating cost for insurance purposes;
- establishing record keeping requirements

The Association of California Insurance Companies and the Personal Insurance Federation of California (on behalf of Farmers Insurance, Liberty Mutual Group, Progressive Insurance Company, State Farm Insurance Companies, Allstate Insurance, Mercury Insurance, and other insurers) have jointly filed a lawsuit seeking to block these consumer-friendly regulations. The complaint alleges that the regulations restrict insurer underwriting, which is not an area regulated by the Department of Insurance. In response, Commissioner Jones has commented that the insurers “have clearly missed the mark with this lawsuit and their argument simply has no merit” not least because “the replacement cost regulation has nothing to do with underwriting. The industry is free to decide which customers to sell to and at what price, as long as they comply with the voter-approved initiative Proposition 103, make rate filings with the Department, and get them approved. This is just another attempt, in a long line of many, by the insurance industry to strip consumers of the protections they deserve.”

The National Eating Disorders Association (NEDA) commends General Mills for pulling a controversial television commercial for Yoplait yogurt off the air after NEDA voiced concerns that the commercial may encourage disordered eating behaviors.

The commercial shows a thin woman agonizing over the decision of whether or not to eat a piece of raspberry cheesecake. Her internal dialogue shows her rationalizing the choice to eat a slice if she only ate celery sticks for dinner or if she jogged in place while eating it. This is typical of the type of bargaining and rationalizing about food choices conducted by sufferers of eating disorders every time they are confronted with a choice about food. When Lynn Grefe, president and CEO of NEDA and her colleagues first saw the commercial, what they saw wasn’t a woman making a healthy food choice, but one who was caught up in a compensatory exchange about food, Grefe said. “This felt like a 20 second look at the mind of somebody with an eating disorder.”

General Mills responded to the concerns by immediately taking the commercial off the air. Tom Forsythe, vice president of corporate communications for General Mills said, “[A]ny correlation was certainly unintentional. But if even a few people could take from the ad that mis-impression, then the right thing to do was to pull the ad—and we have.” In a public statement, Grefe thanked Yoplait and General Mills for addressing their concerns so quickly and stated, “I believe the company had no intent to harm and gained insight into a very serious issue that we hope will influence their marketing decisions in the future.”

To view the entire commercial and further commentary, go to:
http://shine.yahoo.com/channel/health/does-this-commercial-encourage-eating-disorders-video-2497971/
National Eating Disorder Association (NEDA) website: www.nationaleatingdisorders.org

If you have group disability insurance (through your employment), it is probably governed by the Employee Retirement Income Security Act (ERISA). If your disability claim is denied, under ERISA, you must appeal the denial prior to filing a lawsuit in federal court. We often handle appeals for clients. These appeals offer an opportunity to submit all evidence of disability, including medical records, results of evaluations designed to measure a person’s ability to work, doctor’s clinical notes, physical therapy notes, and even personnel files showing that a person performed well on the job, prior to stopping work due to disability. Generally, the appeal is the last chance a person has to submit evidence of disability, as a court may not hear witnesses or consider other evidence outside of what was generated during the claim and appeal period. GETTING ALL YOUR EVIDENCE TO THE INSURANCE COMPANY DURING THE APPEAL PERIOD IS THUS CRITICAL.

Interestingly, we have been noticing that when we submit appeals, claims representatives for insurance companies are attempting to return portions of the evidence we are submitting. This includes such things as information about medications and their side effects, relevant case law, and even video footage we sometimes produce to prove to the insurance company how physically-disabled and limited our clients are. The insurance companies have not produced any legal authority for returning information submitted on appeal, and we promptly send it back. In fact, this type of claims handling by an insurer is prohibited by the ERISA regulations, as among other things, it denies a claimant of her right to a full and fair review of her disability claim. Such a fair review is certainly informed by the claimant’s submission of all evidence which she feels may support her claim for disability.

This tactic by the insurers is a bold attempt to deny claimants full and fair reviews of their claims, as required by law. Worse, to the unsuspecting applicant, the insurance companies might get away with this practice, and thus deny the claimant the right to have all evidence before a court should the matter make its way to litigation. If this has happened to you, push back. If an insurance company is mistreating you or not playing fair in some other way, question them...and always do do in writing, with proof of mailing (or emailing).

If you have questions, or need help with an appeal, visit our website, or call us. We fight these battles every single day. Initial consultations are free. 818-446-7529.