Last month, a Daily Journal investigation found that disability insurers frequently deny or terminate benefits to people who have limited recourse to appeal the insurers’ decisions.

The investigation also found that the California Department of Insurance does little to regulate the practices of disability insurers.

The state Department of Insurance says it does not always have the power to intervene in claims denial cases because the federal Employee Retirement Income Security Act governs employer-sponsored worker benefits.

Assembly Health Committee Chair Dave Jones (D-Sacramento) said the Department of Insurance could wield more power to investigate claims denials and protect disabled consumers. Jones is running to replace current Insurance Commissioner Steve Poizner (R) next year.

Poizner is seeking the Republican gubernatorial nomination.
In related news, some advocacy groups plan to pressure lawmakers to change ERISA regulations if national health care reform legislation requires all residents to have insurance coverage.

ERISA currently prohibits individuals covered under group policies from appealing a claims rejection in state courts or from seeking punitive damages.

Nathalie Blanchard said Monday she was diagnosed with major depression and was receiving monthly sick-leave benefits until payments dried up this fall.

When Blanchard called her insurance provider, Manulife, to find out why, she says she was told the Facebook photos showed she was able to work.

“If you have insurance, be careful. This is a major battle and it’s not going to be easy,” Blanchard, 29, said in a telephone interview from her home in Bromont, Quebec.

She said her insurance agent described several pictures Blanchard posted on Facebook, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday.

Blanchard said Manulife told her it was evidence she is no longer depressed.

Her lawyer, Tom Lavin, said Blanchard was wrongfully dismissed from her benefits, and she had the right to go on holiday.

“The issue for me is that they stopped her disability benefits without the proper medical recommendations. Her doctor recommended she go on vacation,” he said.

Blanchard said she took three four-day trips when she was feeling especially low, on her psychiatrist’s advice.

Manulife declined to comment on the case specifically but has said in a statement that “we would not deny or terminate a valid claim solely based on information published on Web sites such as Facebook.”

Still, Lavin said the issue raises concerns for anyone who expects their private life to remain so if they post personal information to social networking sites such as Facebook.

1. FROM THE NATIONAL ORGANIZATION FOR WOMEN: This bill obliterates women’s fundamental right to choose.
“• Prevent women participating in the public health insurance exchange, administered by private insurance companies, from using 100 percent of their own money to purchase private insurance that covers abortion.
2. FROM THE CALIFORNIA NURSES ASSOCIATION: This bill fails to control costs
3. FROM CONGRESSMAN ERIC MASSA: This bill will enshrine in law the monopolistic powers of the private health insurance industry.

“At the highest level, this bill will enshrine in law the monopolistic powers of the private health insurance industry, period. There’s really no other way to look at it. I believe the private health insurance industry is part of the problem.
4. FROM PLANNED PARENTHOOD’S CECILE RICHARDS: This bill embraces religious-right extremes.
5. FROM CONGRESSMAN DENNIS KUCINICH: This bill worries about the health of Wall Street, not America.
6. FROM “SICKO’S” DONNA SMITH: The bill does not cure what ails us.

The most common reasons for complaints to the department included denial of claims, claims delays, and unsatisfactory offers. The department recorded the most complaints in the following types of insurance: auto, group health, individual health and homeowners.

Some of the highest amount claims recovered were:

•Earlier this year a family of nine from southwest Missouri filed a complaint against their homeowners insurance company regarding a tornado loss that left them in a hotel room for over a month. After the department’s involvement, the family received a final recovery from the insurer of nearly $278,000.

•After being denied coverage for treatment of lymphoma, a consumer filed a complaint with the department. After mediation by the department, the insurance company overturned the denial and approved the procedure, which cost more than $250,000.

•After purchasing life insurance with the proceeds of her late husband’s life policy, a consumer complained that her new policy did not include the benefits she had been promised. After the department’s involvement, the consumer’s policy was re-written and her insurance company returned $109,846 to her.
In the first nine months of 2009, the department fielded almost 4,200 formal complaints and assisted nearly 3,000 consumers in writing and another 21,000 over the telephone.

The top categories of complaints were as follows:
By reason

•Denial of claim
•Delay of claim processing
•Unsatisfactory settlement offer
•Claim handling

By line of insurance

•Private passenger auto
•Group health
•Individual accident and health
•Homeowners

I’ve known Americans who’ve gone to Costa Rica, Venezuela, Peru, Mexico and Austria for medical and dental treatment they couldn’t afford here. (In fact, Logan wrote about this a few weeks ago.) If people are getting on a plane to go somewhere to get treatment, that’s got to tell you something:

MEXICO CITY — It sounds almost too good to be true: a health care plan with no limits, no deductibles, free medicines, tests, X-rays, eyeglasses, even dental work — all for a flat fee of $250 or less a year.

To get it, you just have to move to Mexico.

As the United States debates an overhaul of its health care system, thousands of American retirees in Mexico have quietly found a solution of their own, signing up for the health care plan run by the Mexican Social Security Institute.

Canadian Health care vs American health care
The governments of both nations are closely involved in health care. The central structural difference between the two is in health insurance. In Canada, the federal government is committed to providing funding support to its provincial governments for health care expenditures as long as the province in question abides by accessibility guarantees as set out in the Canada Health Act, which explicitly prohibits billing end users for procedures that are covered by Medicare. While some label Canada’s system as “socialized medicine,” the term is inaccurate. Unlike systems with public delivery, such as the UK, the Canadian system provides public coverage for private delivery. As Princeton University health economist Uwe E. Reinhardt notes, single-payer systems are not “socialized medicine” but “social insurance” systems, because doctors are in the private sector.[21] Similarly, Canadian hospitals are controlled by private boards and/or regional health authorities, rather than being part of government.

In the U.S., direct government funding of health care is limited to Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP), which cover eligible senior citizens, the very poor, disabled persons, and children. The federal government also runs the Veterans Administration, which provides care to veterans, their families, and survivors through medical centers and clinics.

The U.S. government also runs the Military Health System. In Fiscal Year 2007, the MHS had total budget authority of $39.4 billion and served approximately 9.1 million beneficiaries, including Active Duty personnel and their families and retirees and their families. The MHS includes 133,000 personnel, 86,000 military and 47,000 civilian, working at more than 1,000 locations worldwide, including 70 inpatient facilities and 1,085 medical, dental, and veterinary clinics.

“It’s a poor reflection on the industry that there are so many unhappy customers out there,” said Which? personal finance campaigner Phil Jones.

“Financial firms simply aren’t treating consumers well enough and things must change if the industry is to rebuild its reputation,” he added.
There were 908,000 complaints about the mis-selling of mortgage endowments during the period, although their number tailed off dramatically during the three years.

Complaints about credit cards came a close third at 745,000.

But a surge in complaints about payment protection insurance (PPI) saw the number of complaints about general insurance and “pure protection” policies double, from 62,000 to 127,000, between the first half of 2006 and the second half of 2008.
“Millions of transactions for millions of customers go through the banking system every day,” she said.

“Put in context, the proportion of reportable complaints is still very small at 3.5 per thousand products held,” she added.

The vast majority of industry complaints were settled within eight weeks with, by the end of last year, just 10% taking longer to deal with.

Regulators say the money recovered for the first half of the year now totals $22 million.

Gov. David A. Paterson said given the current economic downturn and its impact on state residents, “we will continue to work to make sure New Yorkers get full value for their insurance dollars.”

“Insurance is a promise to protect us at our most vulnerable, and New Yorkers can rely on us to protect them if insurance companies do not keep their promises,” the governor said in a statement.
Among the cases highlighted in the latest round of recoveries by the New York State Insurance Department was a man denied long-term disability benefits due to chronic fatigue syndrome. After contacting the insurance department, an independent medical exam was conducted supporting his claim and a check for more than $75,000 was issued to the policyholder.

In another case, a hospitalized consumer who changed coverage from one insurer to another was refused by both companies for payment of her medical stay. The hospital placed a judgment against the patient for the charged and after the department intervened, the patient’s first carrier paid more than $96,000.t

The letter was sent to the chairmen and ranking members of both the Senate Committee on Banking, Housing, and Urban Affairs and the House Committee on Financial Services and says including insurers under the CFPA will cause confusion.

“At a bare minimum, the CFPA will increase the potential for different and inconsistently-applied consumer protection standards for all insurers and producers, whether those insurers or producers do business locally, regionally, nationally, or globally,” the letter states.

* In a major break with most other large companies, Wal-Mart Stores Inc (WMT.N) Tuesday told the White House that it supports requiring employers to provide health insurance to workers, a centerpiece of U.S. President Barack Obama’s effort to provide near-universal coverage to Americans.

* The Federal Deposit Insurance Corp on Thursday is expected to propose new guidelines for private-equity investors seeking to buy failed banks, people familiar with the matter said.

* Freddie Mac’s (FRE.N) board has made Charles “Ed” Haldeman Jr. its prime candidate for chief executive officer of the government-backed mortgage company, according to people familiar with the situation.

* China’s government delayed its controversial requirement that manufacturers include Web-filtering software in all new personal computers sold in the country — an 11th-hour move that shows the challenges Beijing faces in its wide-ranging efforts to rein in the Internet.

* A regulator fined a unit of ICAP Plc (IAP.L) and one of its former brokers for “numerous improper communications” with rival firms over fees on credit-default-swap trades, in an ongoing probe that could widen to include other brokerage firms.

* Sales of Michael Jackson’s music have skyrocketed since he died suddenly last Thursday, returning the late pop star to the top-selling spot he held more than once during his career.

* The Obama administration’s tough new fuel-efficiency standards could pose problems for some car makers, but Toyota Motor Corp (7203.T) is hoping to benefit. The Japanese company is betting the rules will give an advantage to its expanding lineup of hybrid vehicles, and it also aims to boost revenue by licensing to other car makers the patents that protect its fuel-saving technologies.

* U.S. home prices eased their slide in April, but rising unemployment and shaky consumer confidence are weighing on prospects for a recovery in the housing market and broader economy.

* Financier Allen Stanford is a serious flight risk and must remain in jail until he is tried on charges of masterminding a Ponzi scheme, a federal judge ruled Tuesday.

* Gannett Co (GCI.N), the largest U.S. newspaper publisher by daily circulation, will cut between 1,000 and 2,000 jobs out of its 41,500-person work force in response to continuing revenue declines, according to a person familiar with the company’s thinking.

Progress sought
Baucus’ comments coincided with the beginning of a one-week congressional vacation, and came as he and the Obama administration sought to demonstrate progress on the president’s top domestic priority. President Barack Obama’s goal is to revamp a broken system, reducing costs and providing coverage for nearly 50 million Americans who lack it.

Despite the gains made in lowering costs, Republicans made clear that intense negotiations lie ahead if a bipartisan bill is to emerge.
Republicans and Democrats remain at odds on major issues, including the question of a government-run option for insurance that would compete with private industry. Obama has endorsed the idea, saying it would hold down costs, while GOP lawmakers oppose it.

Another dispute revolves around the Democrats’ call for a requirement on businesses to either provide insurance for their employees or pay into a government fund subsidizing coverage for those who lack it. Many smaller businesses would be exempt, and others would qualify for government subsidies to help them afford coverage, but most Republicans have expressed opposition to a so-called “employer mandate.”