Because of the number of fires in California over the past several years, there are huge shortages of labor and materials for building homes. It can take well over a year for someone who lost their home in a wildfire to secure a contractor and get permits to be able to build.

The California Department of Insurance knows this. On May 18, 2019, the Insurance Commissioner issued a Notice requiring insurers to extend additional living expense (“ALE”) benefits to as long as 36 months if needed for claims made due to a state emergency such as a wildfire, regardless of any time limit in the policy. “Good cause” is specifically noted to be unavoidable delays in the construction process. This can be delays with obtaining permits, or finding a contractor, or getting materials. It can also be delays due to the pandemic.

Note that this extension does not increase the dollar limit of ALE, if any, in the policy, so if your rebuild is delayed, you want to minimize the monthly cost of your lodging and related expenses to stretch it out as long as possible. This extension only applies to fires that occurred on or after September 21, 2018. However, 29 insurance companies agreed to voluntarily provide this extension to victims of the 2017 wildfires as well.

Many employers today provide group life insurance coverage for their employees. A benefit adjacent to group life insurance is accidental death and dismemberment (“AD&D”) insurance. AD&D insurance pays you a benefit if you lose a limb or an eye, or it may pay your beneficiary additional life insurance benefits if you die in an accident.

Most AD&D policies define accident with terms like “sudden,” “unforeseeable,”  “unintentional,” and “external cause” – not exactly concrete and easy to follow guidelines to determine whether a death was accidental or not. When a claim is made to an insurance company for accidental death benefits, the insurer considers the events and actions that caused the person’s death and decides whether the claim meets the policy’s definition of accident. If the death was caused by an injury and not an illness, how did that injury happen? Was the person going about their normal life and was struck down in some way that they did not expect? Were they doing something dangerous and likely to cause injury? As one judge said: “What is an accident? Everyone knows what an accident is until the word comes up in court. Then it becomes a mysterious phenomenon, and, in order to resolve the enigma, witnesses are summoned, experts testify, lawyers argue, treatises are consulted and even when a conclave of twelve world-knowledgeable individuals agree as to whether a certain set of facts made out an accident, the question may not yet be settled, and it must be reheard in an appellate court.” Brenneman v. St. Paul Fire and Marine Ins. Co., 411 Pa. 409, 192 A.2d 745, 747 (1963)

The decision of whether a death was an accident often hinges on whether the person’s death was “foreseeable.” When analyzing whether a death was foreseeable, the insurer generally first considers whether the person expected to be seriously injured as a result of their actions. Consider a scenario where a person died when they were injured diving off a tall cliff. If that person was a champion cliff diver and regularly dove off tall cliffs, they would not expect to be seriously injured performing such a dive. Second, the insurer considers whether that expectation was reasonable. In the case of our cliff diver, because she had been cliff diving regularly without injury, her expectation to not be injured while cliff diving was reasonable. This analysis becomes more confused in the real world where the facts are not always so clear.

On August 23, 2021 Kantor & Kantor, LLP filed a complaint against Blue Shield of California in the Superior Court for the State of California, County of Los Angeles alleging Breach of Contract, Breach of the Implied Covenant of Good Faith and Fair Dealing, and violation of California Civil Code Section 3428.

After a routine mammogram in 2013, and a subsequent biopsy, Kantor & Kantor’s client, a 59-year old woman, was advised her risk of developing breast cancer was higher than the general population based on the presence of the papillomatous tissue. Upon being advised that she would be a good candidate for one stage breast reconstruction, plaintiff underwent a bilateral mastectomy with bilateral breast reconstruction in February of 2014.

In 2019 the plaintiff contacted her surgeon reporting chronic pain over the chest wall and into her back, despite physical therapy. Plaintiff reported that the pain had gotten consistently worse over a few years and was limiting her activity and causing daily pain.

The United States Department of Education recently announced it would forgive the student debt of more than 300,000 disabled borrowers. Could this impact your long-term disability benefits?

The topic this pertains to is offsets (amounts that can be subtracted) that insurance carriers are allowed to take from their claimants’ benefits. The “Other Income” provision of your group long-term disability policy sets forth the types of “income” a claimant might receive that the carrier would be allowed to offset – subtract – from the benefit it pays.

Typically, group LTD policies list things like: Social Security Disability Income benefits, Dependent Social Security Disability Income benefits, Workers’ Compensation benefits, certain pension benefits, and income from third party settlements, among others. The claimant must notify the carrier when he or she receives these benefits and the carrier will then calculate the amount it gets to offset, as well as whether it believes it has “overpaid” the claim.

Kantor & Kantor asks to file a class action against Primerica Life Insurance Company for its failure to provide insureds with the right to designate a third party to receive notice of lapse 

Are there ways to prevent a life insurance policy from lapsing? Sometimes the answer is yes. However, often it requires particular knowledge of the law.

On August 13, 2021, Kantor & Kantor filed a motion asking the Federal District Court for the Central District of California to allow the amendment of a complaint to bring class action allegations against Primerica Life Insurance Company. The class action asserts that Primerica has a business practice of failing to provide California insureds with their statutory right to designate a third party to receive notice that a life insurance policy will lapse.

Lipedema is a condition that causes excess fat to accumulate in the lower part of the body. Lipedema most often involves the buttocks, thighs, and calves. The upper arms can also be affected. The condition does not affect the hands or feet. It can also lead to debilitating symptoms if left untreated, including chronic pain and the inability to walk or move around easily.

What Causes Lipedema?

The exact cause of lipedema is unknown. But the condition runs in families and may be inherited. The condition occurs almost exclusively in women, and usually starts or gets worse at the time of puberty, pregnancy, or menopause. Because of this, there is likely a connection to hormones. Lipedema is not caused by obesity but more than half of patients with this condition are overweight or obese.

The internet provides patients with the resources to locate healthcare providers anywhere in the world. But whether your health insurance pay benefits for treatment with a health care provider anywhere in the world is another issue. Patients are often unhappily surprised when they discover that their health insurance policy limits them to healthcare only within their state or within the health insurance company’s network of providers.

The first step to understanding your health insurance coverage is requesting a copy of the policy. The policy dictates your healthcare coverage. Review your policy to learn whether your policy provides benefits if you go out of state, or out of the country, or see an out-of-network provider for treatment.

If the policy limits you to in-network or in-state benefits and you find a healthcare provider that is perfect for your needs, don’t lose hope. If you can show that there is no in-network or in-state health provider appropriate to treat you, you have a good argument for asking for out-of-network or out-of-state coverage even if the policy only approves in-network or in-state providers. The best argument will demonstrate that there are no in-network providers willing to take new patients or it is outside of their area of expertise. This argument will require through research through many telephone calls to in-network providers to determine whether they will accept the patient. Similarly with out-of-state providers, the argument requires research to demonstrate that there are no in-state providers available.

With the massive increase in wildfires throughout California, the Department of Insurance has adopted what is now an annual tradition of ordering insurance companies to refrain from policy cancellations and non-renewals in wildfire areas.  This year is no exception. On August 19, 2021, the Department of Insurance issued a one-year moratorium on cancellations or non-renewals of fire policies in the areas affected by the Lava and Beckwourth Complex fires.  More than 26,000 homes are affected, in Siskiyou, Lassen and Plumas counties.  This area was already included in last year’s moratorium, but this new order buys those policyholders another year.

Commissioner Lara’s office has stated that he intends to issue a similar moratorium for the Dixie and Caldor fires, once the perimeters of those fires are better established. The Dixie fire is currently only 35% contained. The Caldor fire is currently not at all contained.

These moratoriums are temporary respites from the insurance industry’s practice of non-renewing homes that are in wildfire areas. For homeowners who do lose their insurance because of their location, the “option of last resort” is the California FAIR Plan. This plan offers bare-bones coverage for fire coverage only.  The Department of Insurance ordered FAIR Plan to offer personal property coverage and liability coverage as well in 2019. The insurance industry has been fighting that, and in July 2021 a California superior court ordered FAIR Plan to comply.  Where FAIR Plan will likely appeal that decision, the ability to access this expanded coverage may not actually happen for some time to come.

I want to preface this blog post by saying that I do not have a long-term disability. However, for 16 years of my life, I suffered a life-threatening illness –an illness that I was told that I would either a) die from or b) never fully recover from. Time and time again during those 16 years, I was told to give up hope for any semblance of a normal life, or just resign to dying prematurely. For 16 years, I believed that I should not have hope and there came a point in my journey when I finally gave up all hope and I resigned myself to dying. As fate would have it, on the very same day that I had resigned myself to dying, I ended up having life-changing encounters with human beings who inspired me to fight back and begin the journey to reclaim my hope. Reclaiming my hope was not easy, to say the least. It took me two long and arduous years to reclaim my health and to restore hope, overcoming the odds that were stacked against me. One of those odds was my insurance company –it had told me time and again that I was not sick enough to have my medically necessary treatment covered by insurance. Those two years of fighting for myself, fighting back against the mental defeat I felt because of insurance telling me that I didn’t deserve benefits, during those two years, there were times when it was incredibly hard to hang on to any semblance of hope. I had to remind myself that, “Hope exists. If for no other reason than the Dictionary says it’s a word.”

After I fully healed from the illness, I took my newfound hope and went on to serve as Policy Director on Capitol Hill for a small non-profit dedicated the illness that I had once suffered. In that role, I advocated to raise awareness of that disease, and to get a Federal Bill passed on behalf of people suffering that disease. Once again, the odds were not stacked in my favor. I ended up spending over 10 years advocating with that tiny non-profit on Capitol Hill. During that time, I lost more people to the disease than I can count (meaning, they died), and I heard from people all across the country who had lost loved ones to that disease. Trust me when I say, despite my faith in God, it was not always easy to remain hopeful –I admit that, at times, my hopeful spirit dimmed. But finally, in December 2016, provisions from the bill passed. That day in December was one of jubilation…and yet of humble quiet. The passage of the bill was subdued because it was long-overdue and long-awaited for 16 years, especially by the family after whose daughter the bill was named. The bill was named after Anna Westin who died in 2000 after insurance denied benefits for her treatment.

On ‘the Hill,’ I learned many things. One of the most eye-opening things I learned was: No matter how worthy the cause, the odds are stacked against you if you want to get a bill passed. In fact, in 2016, out of the 12,000+ pieces of legislation that were introduced, only 3% (three percent) passed/were enacted into law.

Glioblastoma, also known as glioblastoma multiforme, is an aggressive type of cancer that can occur in the brain or spinal cord. Glioblastoma can occur at any age but tends to occur more often in older adults. Many glioblastoma symptoms develop slowly and get worse over time. Common symptoms may include:

  • Headaches
  • Loss of appetite
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