Posted by: Elizabeth K. Green
When we refer clients to the California Department of Insurance (“DOI”) to report problems with their insurance company’s handling of health claims, it may seem like a wasted effort. After all, the DOI is a large state agency and our clients are just individual patients. A new decision by the California Supreme Court shows that the DOI represents the interests of consumers on a large scale and, even more, the DOI has the power to fine insurance companies that violate insurance regulations.
The California Supreme Court has upheld the DOI’s right to collect $91 million in fines for UHC’s mishandling of health claims. United Healthcare Group now has the ominous reputation of being the largest health insurer in the country, AND the insurer charged with the largest number of insurance regulation violations ever committed in California state history.
The DOI, like other state departments of insurance, is charged with the duty of overseeing insurance companies to ensure that insureds are being fairly treated and claims are properly paid in accordance with California state insurance regulations. The DOI has the power to apply fines to insurance companies that violate state insurance regulations. The DOI found violations such as denying treatment for people with serious illness and claim payment denials for providers and hospitals. The DOI does not need to show that the insurance company intended to break the law or engaged in a general practice of misconduct. The DOI can apply fines when an insurance company should have known that their actions were in violation of state insurance regulations.
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If you are currently struggling with a denied or delayed insurance claim, our California disability attorneys are here to help. Contact Kantor & Kantor, LLP to request a FREE consultation. We can be reached at (818) 886-2525 or via our online contact form. You don’t pay unless we win your claim, so you have nothing to lose!