RICO laws in litigation againsy insurance companies.">
HMO, ERISA, Insurance and Court News
-
Court Overturns Disablity Time Limit
-
A few new items from New York Times and LA Times
-
Class Action Against UNUM Insurance Company
-
Testimony before Nevada legislature about HMO care
-
Punitive Damages awarded under ERISA
-
Credit Checks by Insurance Companies (Yang v Geico)
-
UNUM ORDERED BY COURT TO PRODUCE DOCUMENTS BY AUGUST 31, 1998
-
MURDER BY HMO
Court Overturns Disablity Time Limit
From judydoc@the-spa.comThu Jul 23 18:15:05 1998
Date: Tue, 21 Jul 1998 09:53:00 -0400
From: judy morris
To: judydoc@the-spa.com
Subject: Re: Court Overturns Disablity Time Limit
The following is from Florida Agent, July 1998,a publication for
insurance agents.
A long term disability insurance policy limiting benefits for mental
but not physical illness violates the Americans with Disabilities
Act, a federal judge ruled.
Judge Leonie M. Brinkema of the U.S. District Court in Alexandria,
Va. ordered Kmart to resume paying Harold Lewis disability benefits
until he turns 65.
Disabilities rights activists hailed the decision as a victory.
The matter is hardly settled since two U.S. Appeals courts have
ruled the other way.
The judge ruled that for Kmart to win they would have to show that
its offer of lesser mental health benefits was based on " sound
actuarial principles". The company fail to do that.
------------------------------------------------------------------------
A few new items from New York Times and LA Times
Date: Wed, 22 Jul 1998 00:45:49 -0400
From: judy morris
Subject: A few new items from New York Times and LA Times
July 21, 1998
Hold H.M.O.'s Liable for Bad Care
To the Editor:
The only reason that health maintenance organizations are signing on to
legislation regulating their industry is because they are
trying to avoid the one piece of legislation that would truly protect
the public (editorial, July 17). The only way to crack down on
the H.M.O.'s and to stop their widespread abuse of patients is to make
it clear that when they dictate medical decisions, they are
practicing medcine without a license.
Any legislation that Congress passes to protect the American people must
include provisions that hold H.M.O.'s and their
executives personally accountable for such actions and allow for civil
remedies and punitive damages against them. H.M.O.'s
favor what they call independent appeal panels, but with these managed
care companies controlling doctors' lives, no such panel
could be independent.
HARVEY F. WACHSMAN, M.D.
Great Neck, N.Y., July 17, 1998
To the Editor:
The H.M.O. Group, a coalition of 25 health maintenance organizations,
opposes legislation that would allow consumers to sue
insurance companies when benefits are improperly denied (editorial, July
17).
Paradoxically, the Employee Retirement Income Security Act, the law that
shields H.M.O.'s from liability suits, was instituted as a
safeguard for the consumer, whose hands it now ties. The H.M.O. Group
claims that being subjected to lawsuits would increase
consumer costs, because it would increase industry spending. Yet the
insurance industry is not shy about spending millions of
dollars on public relations campaigns, which increases in consumer costs
no doubt help finance.
If the managed care industry were honest about its good intentions, it
would subject itself to legal scrutiny.
TAMARA CLAMAN
Chicago, July 17, 1998
To the Editor:
It is disappointing to see President Clinton and his Democratic
colleagues champion the right to sue ahead of all other patients'
rights enumerated in proposed managed care legislation (news article,
July 17). As both political parties weigh in with proposals
for such legislation, the right to sue stands out as a divisive issue
that could kill any chance for meaningful reform.
Of course managed care plans should have to pay when their decision to
deny care results in physical or economic injury.
The most expedient means toward that end is to amend the Employee
Retirement Income Security Act, which was intended to
regulate pension plans, so that it no longer regulates employee benefit
plans.
COLLEEN C. BUTLER
Chicago, July 17, 1998
To the Editor:
It is not surprising that health maintenance organizations seem ready to
accept many of the tenets of the proposed patients' bill
of rights but remain opposed to being held liable for their decisions
(editorial, July 17). The concessions they are willing to make
are small stuff compared with real accountability.
For example, if a psychiatrist wishes to hospitalize a suicidal patient,
approval must be obtained from an H.M.O. or managed care
group. If approval is denied, it is the psychiatrist who is forced to
indemnify the H.M.O. or managed care group for its decision
should there be an adverse outcome.
H.M.O.'s say it isn't good when government plays doctor by writing laws
governing their practices. Neither should citizens accept
a status quo that gives license to H.M.O.'s to make clinical decisions
unless they are held liable for those decisions.
BARRY B. PERLMAN, M.D.
Garden City, N.Y., July 17, 1998
The writer is vice president, New York State Psychiatric Association.
To the Editor
It is paradoxical that Senator Edward M. Kennedy is among those leading
the charge against health maintenance organizations
(front page, July 16). Five years ago he supported a national health
insurance plan that amounted to a Government-run H.M.O. In
an effort to revive his dream, he would now decry the horrors of private
health maintenance organizations' deciding how much
health care we may have.
The Democrats complain that we cannot sue H.M.O.'s if they commit
malpractice. But will their plan allow us to sue the
Government if it commits malpractice? Granted, H.M.O.'s have not solved
the health care problem, but neither will more
government. Why not a supply-side solution -- increase the number of
doctors and drive down the price through competition?
DAVID E. PETERSON
Winter Park, Fla., July 17, 1998
(Copyright 1998, The New York Times. This article reproduced for
educational purposes only.)
-----------------------------------------------------------------------
Class Action Against UNUM Insurance Company
Date: Wed, 22 Jul 1998 20:51:39 -0400
From: judy morris
Subject: Re: Class Action Against UNUM Insurance Company
Here's a law firm interested in a Class Action against UNUM. Please
spread the word. As usual I can't vouch for the integrity of any lawyer
or law firm, but I know Robert Perez is on the "right" side. You can
read some of what he's written about ERISA on the Web Site
HARP.org
He wrote something called Fundamentals of ERISA Litigation. He's been
receiving my posts and has gotten his law firm interested in this issue.
Let's show them just how BAD UNUM is! Spread the word on the newsgroups
and support groups. I'm sure there are still plenty of unrepresented
victims out there.
Judydoc
> Thank you for your interest in our investigation of Unum's practices. We
> are intereseted in examining denials of claimants who are not represented
> by attorneys and have not filed suit. These people are potential class
> action plaintiffs. We would like to see the insurance certificates and
> all of the correspondence to and from Unum. My address is
>
> Robert Perez, The Perez Law Firm Co. L.P.A.
> 7672 Montgomery Rd.
> Cincinnati, OH 45236
> Tele 513-891-8777
-----------------------------------------------------------------------
Testimony before Nevada legislature about HMO care
Date: Thu, 23 Jul 1998 11:11:17 -0400
From: judy morris
Subject: Testimony before Nevada legislature about HMO care
More HMO Horror stories exposed to the public. I really think that even
if RICO wasn't working before, the tide is turning. NONE of the laws
that the insurance companies spout to defeat lawsuits in State Court OR
RICO WAS INTENDED to give insurance companies or ANYONE carte blanche to
engage in widescale Constructive Fraud, deceit and manslaughter.
As one of the people testifying in Nevada said, during the process of
selling him the insurance there were NO communications problems. All
the problems occurred AFTER the claims were filed. How can a company be
so GOOD at selling insurance and collecting premiums, but the same
company has such a hard time paying legitimate claims, that they'll only
pay when the patient threatens to go to the PRESS or the Government (and
as my case has clearly shown, in some cases, that doesn't even help).
I want to know how long the insurance companies can keep using the SAME
OLD EXCUSE OF INCREASED INSURANCE PREMIUMS as an excuse for fraud,
deceit, and manslaughter, all the while RAISING PREMIUMS ANYWAY?
Is ANYONE ACTUALLY BELIEVING THIS BESIDES TRENT LOTT?
Judydoc
david wrote:
>
> Howdy,
>
> One of our more literate allies has drawn to my attention Mr. Christopher
> Hitchens' wonderfully HMO-skewering "Bitter Medicine", in the August isssue
> of VANITY FAIR. One of the main foci of the lengthy (but very readable)
> article is the testimony presented to the Nevada state legislature on their
> patients rights bill. Also included is a brief (and enlightening) history
> of managed care and "HMO's" (which term Mr. Hitchens rightly points out is
> a misnomer).
>
> Sadly, the article is not available online, but it's well worth a trip to
> your local newsstand, library, dentist's office, or recycle bin.
>
> Happily, on the other hand, a summary (also lengthy but readable once you
> get past the boilerplate) of the Nevada hearings on A.B. 156 ("Minutes of
> the Assembly Committee on Health and Human Services", Feb 22, 1997) is
> available online at the (yes, also lengthy, but you do have cut-and-paste,
> don't you?) URL:
>
> Nevada Hearings Summary
> http://www.leg.state.nv.us/97minutes/AM/HH/am2-22HH.htm"
>
> Enough to get you through an afternoon at the beach, and certainly much
> scarier than a Stephen King novel.
>
> Carry on,
>
> David
Testimony before Nevada legislature about HMO care
Date: Thu, 23 Jul 1998 15:14:53 -0400
From: judy morris
Subject: Something to look into re:
a case where punitive damages were awarded under ERISA
> From: Broncorudy
> Newsgroups: alt.med.cfs
> To: CFS-L@MAELSTROM.STJOHNS.EDU
> Date: Thursday, July 23, 1998 1:23 AM
> Subject: Re: Disability Insurance- Metlife
>
> in my research of CFIDS cases and Fibromyalgia cases, there have been
> legal > fees that have been awarded to the winning party. It is not
> true that "punitive" damages can't be awarded, but it is rare.
> In Godfrey V Bell South Telecommunications the court noted,
> "Under ERISA Section 502(a)(3), 29 U.S.C. 1132(a)(3),
> the court has the power to grant equitable relief to redress
> violations of ERISA or violations of the benefit plan."
>
> Rudy
Credit Checks by Insurance Companies
Date: Mon, 24 Aug 1998 21:13:53 -0400
Here's recent appelate court decision that
even INSURANCE DON'T have carte blanche to order credit checks on people.
Yang v Geico
http://caselaw.findlaw.com/scripts/getcase.pl?navby=search&case=/
data2/circs/11th/978432opn.html
I'll analyze this case with quotes later.
Date: Thu, 10 Sep 1998 10:53:15 -0400
Subject: FCRA - Fair Credit Reporting Act
Case Yang v. Geico DC Docket No. 1:95-CV-3287-JOF
I believe, although this case has extremely circular logic, that the
point is being made that although Geico claims the report in question is
NOT a credit report and therefore not subject to FCRA because it wasn't
USED for an approved purpose, that the court found that the report was
indeed covered under FCRA because it was PREPARED by Equifax to be USED
ONLY FOR APPROVED purposes.
The report sought by Geico after an insurance claim was filed is called
an IAR (inquiry Activity Report) and was computer generated by something
called ARCO (Automated Credit Reporting On-Line).
I think we have a case against these Credit Reporting Companies to ensure
that the reports they are generating are NOT used for unapproved purposes
by insurance companies (as a means of harrassment and finding out
information they have no right to) and also because everytime a report is
REQUESTED from the agencies, the fact that a request was made gets put
into the reports, and some institutions consider the LENGTH of a credit
report as an indication of a lack of credit worthiness.
Geico's reasons for requesting this report were, of course, pure
defamatory BS, as I'm sure we will find in many of our UNUM cases where
reports are "routinely" requested.
-------------------------------------------------------------------
UNUM ORDERED BY COURT TO PRODUCE DOCUMENTS BY AUGUST 31, 1998
Date: Mon, 24 Aug 1998 21:13:53 -0400
UNUM ORDERED BY COURT TO PRODUCE DOCUMENTS BY AUGUST 31, 1998
This is the latest from Steve Russell and Lee Hoffman. They are the
ones who got the Arizona Supreme Court Decision that UNUM must produce
documentation concerning all lawsuits filed for denial of disability
benefits since 1994. UNUM has been ordered to produce all of the
documents by the 31st of August or they are in contempt of the Arizona
Supreme Court.
Attorney Hoffman also invites any attorneys with lawsuits against UNUM
to come to his office and review the case file. Here's how to contact
him: (602) 254-5341 HSSlaw@aol.com
Update:
It is now well past the August 31, 1998 deadline and UNUM has defied
the Order of the Supreme Court of Arizona to produce the documents, and
therefore UNUM is in potential contempt.
MURDER BY HMO
Date: Wed, 16 Sep 1998 18:56:53 -0400
Listmember wrote:
The los angeles times today, sept 16, 1998 on page one of the front
section published an article entitled "Pressure Mounts to let consumers
sue HMO's" The article sets forth several matters in which people were
denied healthcare treatment under their employee sponsored HMO's which
led to their deaths. Because ERISA controlled, they and their survivors
could not collect damages. I will write to the staff writers and alert
them to the issues involving disability policies.
My response:
judy morris wrote:
As Dick Van Dyke said on his show Diagnosis Murder when HMO red tape led
to the death of a child and the delayed diagnosis of cancer in another
person "It's MURDER."
And it is - it's Premeditated Negligent Homicide. (i.e. murder)
By denying benefits that the court rules SHOULD have been given, and
knowing the consequences could be death, but thinking they are protected
by ERISA, it's PREMEDITATED MURDER. I want to know when people are
going to wake up and realize the insurance industry (at least some of
it, the biggest companies) have DECLARED WAR ON THE AMERICAN PEOPLE.
It's a Class War - the rich against the poor (although ironically in
this case - the poorest, those with NO health insurance are better off.
At least they are not PAYING for the Privelege of BEING MURDERED.)
It's PREMEDITATED, it's malicious, and the PATTERNS of abuse are
becoming VERY clear even without an insider "confessing." Although we
already have Dr. Linda Peeno and her courageous battle that the
government is WILLFULLY ignoring.
Just as what's going on in Bosnia is still a war, and each death is
still a murder, no matter how much they claim it's just "ethnic
cleansing."
What's going on in this country is still war, it's still premeditated,
and it's about nothing but MONEY. There aren't even any higher
principles involved here. The insurance companies after all supposedly
have lots of DOCTORS acting as executives and medical directors who
SHOULD KNOW that denial of certain treatments MAY result in death or
injury and they have lots of lawyers who KNOW OR SHOULD KNOW that some
of these denied benefits are CLEARLY COVERED by the policies.
As reported in the Miami Herald
The brilliant 34 year old psychologist daughter of Joan E. Childs, a
social worker and her physician (ex?) husband jumped 15 stories to her
death in July after a struggle of several years not only against her
neurobiologial (i.e.mental) illness, bipolar disease, but also years of
battling for proper treatment with her HMO. Her parents lost not only
their daughter, but their trust in ANY promise any one might make, just
as I have, thanks to the repetitive broken ones of our corporate
"benefactors."
By the way, to those of you who still think I'm too hard on the
insurance industry because SOME people manage to get SOME care. How
about the analogy of a parent who manages to feed and cloth his
daughter, gives her the best money can buy, but sexually abuses and/or
beats her on the side. This person is no more a wonderful parent than
is an insurance company who promises protection and then abuses 10% (or
ANY percent) of it's claimants is worthy of ANY accolades.
Insurance Page
Uncivilization and its Discontents
Home Page
Email Judy Morris
at: judydoc AT the-spa DOT com
Email me
at: bhammel AT graham DOT main DOT nc DOT us
The URL for this document is:
http://graham.main.nc.us/~bhammel/INS/jm03.html
Created: July 24, 1997
Last Updated: May 28, 2000