insurance coverage Tag Archives — California Insurance Lawyer Blog

September 30, 2021

October is Breast Cancer Awareness Month

Breast cancer is the most common cancer diagnosed among women in the United States and is the second leading cause of death among women after lung cancer. On average, every 2 minutes a woman is diagnosed with breast cancer in the United States.

According to the Breast Cancer Foundation, in 2021 an estimated 281,550 new cases of invasive breast cancer will be diagnosed in women in the U.S.
Although rare, men get breast cancer too. In 2021, the projection is that 2,650 men will be diagnosed with breast cancer.

September 28, 2021

When You Stop Working For Your Current Employer, What Happens to Your Life Insurance Coverage?

by Sarah Demers

Group life insurance is a common benefit provided by employers to their workers. But unlike a private life insurance policy, your coverage is contingent on you remaining an employee. So when you stop working at that employer, what happens to your life insurance coverage?

There are multiple ways to keep your life insurance coverage from your employer once your employment ends, but it is important to choose the correct option. The possibilities might include conversion, continuation, or porting the coverage. Each of these will be specifically defined in your life insurance policy along with the procedure and conditions for exercising that option. Carefully consider each option available to determine what best fits your needs. An experienced employee benefits attorney can help you understand your life insurance policy if you have questions.

You Can Convert

September 27, 2021

The Rise of Natural Disasters and Your Familiarity with Your Homeowners Policy

by Jaclyn D. Conover

Your news feed is constantly cluttered with natural disasters – wildfires, hurricanes, and floods seem to have become part of our daily conversations. According to a recent study by the Institute for Economics and Peace, natural disasters on a global scale have increased ten times since the 1960s. We often absorb this information with sorrow for those affected by the disaster, without stopping to think what we would do if our own home were affected. If you open mail for your homeowners insurer and stuff it in a draw or throw it in the garbage, this brief post is intended to help give you some tools to be a more proactive homeowner in the event you do need to file an insurance claim.

In order to adequately protect yourself before any potential loss, you should be intimately familiar with your homeowners policy. Upon receipt, you should set aside time to thoroughly review a complete copy of your homeowners policy. Highlight sections that are concerning to you and contact your agent for answers. Ask yourself questions such as:

What is the current value of your home?

September 2, 2021

National Suicide Prevention Week Sept 5 – 11, 2021

by Kathleen MacDonald

In 2017, 47,000 Americans died by suicide and 17.3 million adults suffered at least one major depressive episode. When I see statistics like those, my mind floods with a flurry of thoughts all at once:

“Why?”
“How many more have died by suicide since 2017?”

September 1, 2021

September is National Recovery Month

by Cari M. Schwartz

September is National Recovery Month and is an observance held every September to promote and support new evidence-based treatment and recovery practices, the emergence of a strong proud recovery community, and the dedication of service providers and community members across the nation who make recovery in all its forms possible.

Mental health and substance use disorders affect all communities nationwide, with commitment and support, those impacted can embark on a journey of improved health and overall wellness. The focus of National Recovery Month this September is to celebrate all people that make the journey of recovery possible by embracing the 2021 theme, “Recovery is For Everyone: Every Person, Every Family, Every Community.” National Recovery Month spreads the message that people can and do recover every day.

Mental health and substance use disorders affect people from all walks of life and all age groups. These illnesses are common, recurrent, and often serious, but they are treatable, and many people do recover. Mental disorders involve changes in thinking, mood, and/or behavior. These disorders can affect how individuals relate to others and make choices. Reaching a level that can be formally diagnosed often depends on a reduction in a person’s ability to function because of the disorder. For example:

August 31, 2021

What to Look for In Your Health Insurance Policy, Part 2: Lessons learned from NPR series “Bill of the Month”

by Elizabeth K. Green

I highly recommend the NPR series, “Bill of the Month,” which offers an expert analysis of medical bill surprises. This month’s bill concerns jaw surgery and a hospital bill of more than $27,000. The patient, Ely Bair, had a condition requiring two jaw surgeries. The first jaw surgery went very well and Bair paid his out of pocket maximum of $3,000 and his employer’s health plan with Premera Blue Cross covered the rest.

Bair’s second jaw surgery was with the same hospital and the health insurer was also Premera. But this time, Bair received a bill of $27,119 from the hospital.

The reason is in the fine print. Although Bair was covered under Premera policies for both surgeries, he changed employers between the two surgeries. Although both employers used Premera, the insurance coverage provided by Premera was different with each employer. The second Premera plan had a lifetime maximum of $5,000 for this jaw surgery. That left Bair responsible for the rest of the hospital bill. When he appealed, Premera pointed him to the specific language in the 80-page policy that addresses the lifetime maximum for this specific surgery.

August 30, 2021

Is Your Insurance Company Withholding Your Additional Living Expense (ALE) Benefits Until You Begin Construction?

by Stacy Monahan Tucker

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.

August 27, 2021

Kantor & Kantor Files Complaint Against Blue Shield of California for Breach of Contract in a Case Involving Breast Cancer

by Kantor & Kantor LLP

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.

August 23, 2021

What to Look for In Your Health Insurance Policy, Part 1: Does Your Policy Provide Benefits for Out-of-Network or Out-of-State Benefits?

by Elizabeth K. Green

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.

August 20, 2021

California Insurance Commissioner Begins Announcing Ban on Non-Renewals for 2021-2022

by Stacy Monahan Tucker

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.