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from our blog
Seatback Failures
Front occupant seatbacks play a vital safety role in rear-end crashes, similar to the purpose of airbags and seatbelts in frontal impacts. In a rear impact, a front seat should be designed to absorb energy and contain the occupant in the front seating space. Weak, defective front seats can fail, collapse and cause front occupants […]
Better Health Care Provided to AZ Workers
Recent reports indicate Arizona is one of the best employers concerning employee health benefits to workers. Workers in Arizona pay a smaller share of their overall bill compared to the majority of state workers anywhere else in the country. According to analysts, Arizona regularly conducts surveys to compare their benefits on the national stage.
The average state employee in Arizona pays $44 per month for health insurance premium, far below the state’s contribution of $557 per month. To put it another way, a typical state worker pays only 7% of their monthly premium.
The report – originally conducted by the Catherine T. MacArthur Foundation – additionally indicates that only 10 other states pay a higher premium toward health-insurance than Arizona. The numbers are drawn from trends that occurred throughout 2011 – 2013.
Some circumstances like spouses or children add to Arizona state employee’s personal contribution– 11 percent in most cases. Despite the increase, it’s worth noting this figure is still well shy of the national average of 16 percent.
State workers benefit from their robust coverage in a variety of ways, particularly out of pocket expenses. Residents purchasing health care through a private-sector employer or elsewhere are ultimately paying more.
Some health plans for Arizona state employees cover 94 percent of medical expenses, marginally better compared with the national average of 92 percent. AZ state provisions even top the ‘platinum’ plan through the Affordable Care Act, covering 90 percent of overall medical expenses.
Health care is proving to be quite the boon for state workers, even enticing more people to look internally for work. While the state’s decision to expand Medicaid eligibility per federal health care regulations continues to be fiercely debated, little mind has been spent on altering the current state of Arizona worker benefits.
Original story reported by AZ Central.
How to Deal With Insurance Adjustors
Although bad faith lawsuits are extremley complex, the concept of insurance bad faith is a simple one: When you sign up for an insurance policy, there is a reasonable expectation that your insurance company will conduct itself with “good faith and fair dealing.” In Arizona, your insurance company is bound to refrain from any action which would impair the benefits to which its insured had a right to expect from the insurance policy.
One thing to keep in mind is that Arizona does not recognize true “third party” bad faith so you only have these protections against your own insurance company’s unfair claims handling.
While it is not unusual for individuals to disagree with adjustors about how much their claim is worth, bad faith only really comes into play when you notice that an adjustor is dodging any questions or concerns about why a claim is worth what they say, or if they are unexpectedly denying your claims without any reasonable basis. If your adjuster is ignoring evidence that should have been included in the proper, fair evaluation of the claim, this could be bad faith claims handling practicies.
When this happens, it is never a good idea to mention the term “bad faith” in conversation with the insurance agent or adjustor or to threaten bad faith. If you do so, the insurance company will argue that you “set it up” for bad faith even if that is absolutely false. Instead, you should simply make sure that you document and confirm every conversation in writing. Do not give the insurance company any excuses for its unfair claims handling and promptly respond to all reasonable requests from your insurance company.
If the unfair claims handling continues, you should immediately seek legal counsel. Your attorney will be able to go over all your legal options with you, as well as spur the insurance companies to action in most cases.
Keep Tabs on Bad Faith Claims
Imagine the following scenario: You are in need of a serious medical procedure, and after checking with your insurance documentation and finding out the procedure will be covered, you go in for the operation, and it is a success. As you go over your mail later, recovering from your operation, you get a letter from your private health insurance company (or the hospital) stating that the operation was not covered, and you now owe tens of thousands of your own dollars.
You frantically study your insurance paperwork, and can’t find where the insurance company has any legal reason to deny coverage. You call the hospital and the insurance company, and get nowhere.
Unfortunately, this type of thing happens far too often. It can be Insurance Bad Faith, i.e., where an insurance company knowingly and willfully tries to get out of paying for an expensive medical procedure that should be covered. HUGE CAVAET – if this is an ERISA health insurance plan, Arizona’s bad faith law will not help you.
Even more unfortunate, the private health insurer will often get away with it because insurance consumers don’t know that the private health insurance carrier has a duty of good faith and fair dealing under Arizona law. The sad truth, however, is that most insurance companies only speak the language of money, so in order to make your point known, the only real recourse is suing for breach of contract and insurance bad faith.
Some of the more commonly denied conditions by private health insurance companies are fibromyalgia, chronic fatigue, and PTSD (post-traumatic stress disorder). All of these can be seriously limiting on one’s ability to perform work.
Some of the most common ways that private health insurance companies will try to avoid paying owed benefits are as follows:
- The private health insurer will refuse to acknowledge the condition exists;
- The private health insurer will require you to see a specialist picked by the insurance company (who is likely biased in their favor);
- If an individual does not see this specialist (even if they see 6 others), they will deny on grounds of not enough documentation or that the insured failed to cooperate with the insurer’s investigation; and
- The private health insurer will not accept how serious certain conditions can be, and refuse to acknowledge the impact on employment the condition may have.
If you have a talented Insurance Bad Faith attorney on your side, this process can be relatively smooth and less stressful than dealing with the insurance company on your own even if it does take an extremely long time. Either way, you will want to keep your eye on the insurance company’s claims handling at all times. As the years go by, insurance companies are getting trickier and trickier with how they refuse or delay payment on covered claims.
Arizona Stalls Decision to Implement Centralized Insurance Database for Consumers
A major portion of the Affordable Care Act (Obamacare) creates health insurance exchanges in each state. These exchanges allow consumers a one stop shop to compare benefits and prices so they can choose plans that are best suited for them. However, the legislation failed to require states to take on the process of creating these exchanges in their own states. States must decide whether they want to set up their own exchange or have the federal government do it for them. So far at least 16 states (in mostly republican dominated areas) have pledged that they would not invest in setting up the exchange, which could cost hundreds of millions in implanting.
Arizona has not taken an official stance on the issue yet. Governor Jan Brewer said that a decision would not be made until the deadline, Dec. 14, 2012. Governor Brewer’s office has said that they want as much information as possible before undertaking a project of this magnitude.
Governors like Brewer have expressed frustration with federal officials who have allegedly been unable to answer key questions on health reform. Most of these governors face a hard decision where state legislatures comprise of republicans. These legislators are against the Affordable Care Act altogether and view setting up state run health insurance exchanges as approving the controversial measure. With the costs of setting up the exchanges running into the hundreds of millions, legislative support would be necessary to implement the exchanges in most states.
So far the District of Columbia and seventeen states have agreed to implement their own exchange. At least five states have requested a state and federal partnership in setting up the exchange. Seven states, including Arizona are still waiting to decide.
Source: Mary K. Reinhart, Arizona to delay health exchange decision, AZ Insider (Nov. 15, 2012)
Arizona Employers Receive Millions in Insurance Rebates to Forward to Employees
Last summer many Arizona businesses received rebate checks from insurance carriers. This is connected to new requirements for insurance companies. Under the new 80/20 requirement of the Affordable Care Act (also known as Obamacare) insurance companies must maintain a medical loss ratio (MLR) of 80 to 20. If the insurer does not meet this minimum ratio they must provide a rebate of the difference to the insurance policyholder.
The checks were supposed to be mailed in August 2012 to group plan holders. In most cases these plan holders were businesses that administer plans for their employees. After receiving the money an employer then has a duty to determine how to distribute the plan rebate to plan participants, employees.
All employers should have received a notice informing them whether or not they were eligible for the rebate. However, self insured businesses are not covered under the new MLR requirement, which accounts for nearly 60% of persons in group plans.
Businesses have not received information in how to distribute the plan to their employees. A spokesperson for the US Department of Labor Employee Benefits Security Administration stated that the amount of the rebate must be commiserate with the amount that the workers contribute to the premium. This means that if a company pays 80% of its employee’s premiums, the company will keep 80% of the return and must allocate the remainder of the money to its employees.
In Arizona alone over $29.6 million in rebate checks have been sent to businesses throughout the state. Although the average rebate was less than $2,000.
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The Arizona personal injury, accident, and insurance bad faith dispute lawyers at the Law Offices of Shane L. Harward PLC represent insurance, personal injury and accident victims throughout the state of Arizona (AZ) including, but not limited to, Phoenix, Scottsdale, Mesa, Tempe, Chandler, Glendale, Gilbert, Sun West, Sun City, Tucson, Flagstaff, Kingman, Bullhead City, Yuma, Lake Havasu, Fountain Hills, Anthem, Ahwatukee, Carefree, Cave Creek, Gold Canyon, Bisbee, Sierra Vista, Cochise, Paradise Valley, East Valley, Maricopa, Pima, Pinal, Gila, White Mountain, Heber, Payson, Prescott, Forest Lakes, Apache Junction, Avondale, Queen Creek, Benson, Black Canyon City, New River, Buckeye, Casa Grande, Coolidge, Cottonwood, Douglas, Florence, Gila Bend, Goodyear, Greer, Glendale, Lakeside, Guadalupe, Holbrook, Huachuca City, Oro Valley, Overgaard, Avra Valley, Parker, Peoria, Pinetop, Pine, Prescott Valley, Quartzite, Strawberry, Safford, Show Low, Sun City West, Sun Lakes, Superior, Surprise, Snowflake, Tombstone, Wickenburg, Winslow, Wilcox, Williams, Young, Youngtown, and surrounding areas.