ERISA plans also refuse to pay out if you die in a car accident after drinking, on the theory that the accident was not an accident but suicide.

Amschwand-Bellinger received a refund of the few thousand dollars in insurance premiums she and her husband dutifully had paid. The total, she said, would not cover the costs of his funeral.

In others words, they could've started a savings account at a bank and gotten more money vested...

Gotta love those loopholes.

FTA:"The story has played out often under the federal Employee Retirement Income Security Act. Designed to protect employee benefits, the law has been used by employers as a shield against suits."

"Sen. Patrick Leahy, chairman of the Senate Judiciary Committee, said at a recent hearing that before ERISA became law, employees clearly could sue for benefits in state courts.

The court rulings, said Leahy, D-Vt., have left people "more vulnerable than they were before the law was passed.""

No, the law is doing exactly what it was designed to do. Every friggin' law that they say will "protect" us in some way is meant to screw us. Just read Bill Clinton's medical privacy act.

this is what you get with from a democrat controlled congress.

You've got to ask yourself what companies who offer these "benefits" are really selling. If the perpetrators had been anyone else (new window) -there would be jailtime involved.

real shaman:this is what you get with from a democrat controlled congress.

Damn Liberals want to smash our unions and give money to the rich!

Ron Paul Revere:

Aslo FTFA:
The Bush administration has argued that the appeals courts are misreading the precedents and has asked the high court at least twice to clarify the earlier rulings. So far it has refused.

Congress, which could amend ERISA to make clear such suits are allowed, also has taken no action.

Shaman had it right.

Of the three branches only the executive has taken any steps to rectify the situation.

/nice try though

So, kill as many as you can before you fall?

That's bullshiat plain and simple. I hate how the courts always side against human rights.

That reminds me of the dead donkey raffle story:

"A city boy in the Witness Protection Program moved to the country and bought a donkey from an old farmer for $100. The farmer agreed to deliver the mule the next day.

The next day, the farmer drove up and said, "Sorry, but I have some bad news. The donkey died."

"Well then, just give me my money back."

"Can't do that. I went and spent it already."

"Okay then. Just unload the donkey."

"What ya gonna do with him?"

"I'm going to raffle him off."

"You can't raffle off a dead donkey!"

"Sure I can. Watch me. I just won't tell anybody he's dead."

A month later the farmer met up with the city boy and asked, "Whatever happened with that dead donkey?"

"I raffled him off. I sold 500 hundred tickets at two dollars apiece and made a profit of $998."

"Didn't anyone complain?"

"Just the guy who won. So I gave him his two dollars back."

The Employee Retirement Income Security Act makes it harder for people to collect their employer-provided insurance.

The Right to Financial Privacy Act destroyed the concept of financial privacy in its most important sense- privacy from government intrusion.

Don't even get me started on the "USA PATRIOT Act".

Maybe it's time we stopped looking to Congress and the President to solve all our problems?

Another reason to use a CFP. No CFP worth his fee would allow the situation to persist where the client did not have a policy in hand. Before death, lawyers would have gotten the policy.

gilbyguy:Ron Paul Revere:

Aslo FTFA:
The Bush administration has argued that the appeals courts are misreading the precedents and has asked the high court at least twice to clarify the earlier rulings. So far it has refused.

Congress, which could amend ERISA to make clear such suits are allowed, also has taken no action.

Shaman had it right.

Of the three branches only the executive has taken any steps to rectify the situation.

/nice try though

Yeah, no. The Bush people just want to make sure the business can't be liable and have to pay the people anything. They aren't doing this to be nice to you, they're doing this for themselves.

I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

They are a private enterprise, not a charity.

Ron Paul Revere: Blaming the Dems for something the Republicans haven't seen any need to fix either is intellectually dishonest and partisan hackery at its worst.

In other words, business as usual for real shaman.

/and a good majority of Fark, for that matter.

El_Dan:I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

They are a private enterprise, not a charity.

The problem is that insurance companies have a bunch of laws giving them special privileges and that destroy any semblance of market forces (aside from profit motive) on the insurance market.

My wife will be taken care of because her boyfriend is loaded.

El_Dan:I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

They are a private enterprise, not a charity.

Note, however, that this company never gave a copy of the policy, thus making it impossible to figure out whether all provisions were met beforehand. Not exactly a clean way of doing business.

So... always have a copy of any contract signed by both parties for anything involving money? Who'd'a thunk?

This is fundamentally the big problem with your insurance being tied to your employer. In a time when it is not unusual to change jobs every few years, everytime you change jobs, you are a bundle of pre-existing conditions. You have to maintain COBRA from your previous job, etc. It really is time for single payer administered at the state/county level for health/dental.

This was weird, and really an unusual circumstance if I read the facts correctly, the defendant, Spherion, should have just paid it off, and been done with it, but that wouldn't have been maximizing shareholder value.

FTA
The new policy did not take effect until an employee worked one full day. Spherion never informed Amschwand of the requirement.

Amschwand asked repeatedly whether there was anything else he needed to do and was told no. He asked that the new policy be sent to him. Spherion never did so.

Isn't that some sort of fraud? He was lied to and it cost his wife $426k.
There has got to be some other avenue she can take to go after this company. And when the hell will people actually be held accountable? This isn't a company, this is another human making that call.

\Heart cancer!? WTF?!

I hope that people who have no heart
wind up at the hands of people
who have no heart

one day.

Is there any more evil field of business than insurance? Honestly, I think working with the mob or being a spy would be less evil.

Hey Subby and Mods, thanks for submitting this and greenlighting this. Seriously. For various reasons, this is very timely information.

I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

Look, I'm a Life Insurance Underwriter for a major insurance company. I can tell you first hand that there are times when our clients/customers will willingly screw us over and milk us for money they neither earned nor deserved. I can also tell you that from what admittedly little information this article provided, Spherion was acting in a completely unethical way.

/Does not work for Spherion
//Thank god. They're going to take a BIG publicity hit from this, if there's any justice in this world.

BLR:I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

Look, I'm a Life Insurance Underwriter for a major insurance company. I can tell you first hand that there are times when our clients/customers will willingly screw us over and milk us for money they neither earned nor deserved. I can also tell you that from what admittedly little information this article provided, Spherion was acting in a completely unethical way.

/Does not work for Spherion
//Thank god. They're going to take a BIG publicity hit from this, if there's any justice in this world.

I now you deal with life and not health insurance, but would you happen to be able to confirm for me that insurance companies can't deny coverage to people injured in car accidents because they weren't wearing a seatbelt?

/OT

"So... always have a copy of any contract signed by both parties for anything involving money?"

That would be nice, but in this case, the woman and her husband were completely at the mercy of the insurance company. Group-owned life insurance is one of the last avenues that a person has for getting coverage once they've been diagnosed with a lethal illness.

This guy buys and pays for group-owned employer life insurance and takes care of his premiums for years under the impression that even though he's gone soon, his wife's taken care of for at least a couple of years. This is the kind of security Life Insurance is supposed to provide. He had his original contract, but sometime between when he got sick and when he died, his employer switched providers, and failed to work with that provider to ensure this guy was still covered.

It's a very sad situation. My guess is that there was some level of utter FAIL on behalf of Human Resources, the guy's former boss, and the insurance company, but it's very sad.

Oddly enough, this is the kind of situation a LI Company will typically settle on. ERISA must have been a godsend for them.

"I now you deal with life and not health insurance, but would you happen to be able to confirm for me that insurance companies can't deny coverage to people injured in car accidents because they weren't wearing a seatbelt?"

I can unfortunately neither confirm nor deny this. If they have a history of depression in their medical records (and oh yes, those will be pulled and analyzed under a fine tooth comb), the claims department may determine that they were indeed committing suicide. At that point in Life insurance, you need to determine if the suicide happened within the two-year contestability period. If it did happen within two years of policy activation, the premiums may be returned and the policy annulled.

Please note that I work on the front end - evaluating a client's health and background to see if we can offer them coverage, and how much we'd charge. I do not work in claims, and that's where your answer lies.

--------------------
El_Dan 2008-07-05 05:57:37 PM
I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

They are a private enterprise, not a charity.
--------------------

If you or I operated like the insurance companies do, we'd be doing time in jail for fraud.

BLR:/Does not work for Spherion
//Thank god. They're going to take a BIG publicity hit from this, if there's any justice in this world.

From the article, they seem very gleeful over saving $300,000, which would seem to be complete chump change to them.

If someone were to get violent on their ass, and including their CxOs, I would not bat an eyelash. I suspect though that they won't take any publicity hit over this.

Universal.
Health.
Care.

ScubaDude1960:No, the law is doing exactly what it was designed to do. Every friggin' law that they say will "protect" us in some way is meant to screw us. Just read Bill Clinton's medical privacy act.

In his defense, which you won't see from me very often, regulators often seem to ignore both the intent and the letter of the law when they fine-tune federal regulations. To give another example: for many years, some health insurance plans specified that they wouldn't insure those who engaged in motorcycle or horseback riding (or other) activities, even though those the activities were legal, albeit dangerous. Congress passed a law that said that insurers could not discriminate based on legal activities. If you read the debates and so forth, it was very clear that Congress intended that insurance companies couldn't deny coverage based on any legal activity - and that was what the law said. But, when the actual regulations were rewritten, they were written to say that while a policy couldn't be denied based on these activities, the companies didn't have to actually pay if a specific injury was incurred during participation in such an activity. This was clearly in violation of the law, but Congress had left the details up to the executive branch and they chose to ignore the law. It's still the fault of Congress for letting others write regulations, but their intent is often subverted by federal regulators with an agenda. Lots of stupid in DC.

funmonger:Universal.
Health.
Care.

Why should I pay for some Alpha Centurian's healthcare?

ChubbyTiger:ScubaDude1960:No, the law is doing exactly what it was designed to do. Every friggin' law that they say will "protect" us in some way is meant to screw us. Just read Bill Clinton's medical privacy act.

In his defense, which you won't see from me very often, regulators often seem to ignore both the intent and the letter of the law when they fine-tune federal regulations. To give another example: for many years, some health insurance plans specified that they wouldn't insure those who engaged in motorcycle or horseback riding (or other) activities, even though those the activities were legal, albeit dangerous. Congress passed a law that said that insurers could not discriminate based on legal activities. If you read the debates and so forth, it was very clear that Congress intended that insurance companies couldn't deny coverage based on any legal activity - and that was what the law said. But, when the actual regulations were rewritten, they were written to say that while a policy couldn't be denied based on these activities, the companies didn't have to actually pay if a specific injury was incurred during participation in such an activity. This was clearly in violation of the law, but Congress had left the details up to the executive branch and they chose to ignore the law. It's still the fault of Congress for letting others write regulations, but their intent is often subverted by federal regulators with an agenda. Lots of stupid in DC.

Easy way to solve that-

http://www.downsizedc.org/write_the_laws.shtml

El_Dan:I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

Perhaps this is an indication that insurance is not something that should be handled by the market?

Why would anyone care? After all, when you're dead why would you care what happens to your spouse? You're dead.

I forgot my slashies:

/Dead people can't get sex, so spouses are worthless
//Then again, since spouses never give you sexin' anyway why do people have them?

RemyDuron:
Perhaps this is an indication that insurance is not something that should be handled by the market?

Heh...that's actually a good way to look at it. "Let the market decide!.....Huh? What's that?....Oh...it decided? Well, what'd it decide?....Oh....Oh, I see....Oh..."

funmonger:Universal.
Health.
Care.

Do you REALLY want health care to be run by the US Government?

/motrin and water

Heh, my whole check was gone. C'est la vie.

King Something:funmonger:Universal.
Health.
Care.

Do you REALLY want health care to be run by the US Government?

/motrin and water

I'm guessing he doesn't.

Hence why he said universal and not socialized healthcare.

King Something:funmonger:Universal.
Health.
Care.

Do you REALLY want health care to be run by the US Government?

/motrin and water

Yeah, I do. I'd rather a fool than someone who is only interested in me for money.

Reminds me of what happened with my mom's life insurance. She'd been terminally ill for 15 years, and had a life insurance policy through my dad's employer (he'd been working there for 30 years, and had gotten the plan before my mom fell ill.) Her medical expenses were so high that my dad had to take out an additional plan on top of the other one to cover the costs, with enough left over, at my mom's request, to pay for my grad school fees after she died (she knew she wouldn't live that long.)

It turns out that the modifications (this was buried in tiny print somewhere on page 35 of the contract) reset the clock for the plan, requiring it to be active for a year before it took effect. If dad had known that, he wouldn't have made the modifications, and we would have at least gotten $300k. Mom passed away on month 11 of the modified plan... we got the lowest amount possible, $10,000, not the $500k that would have paid off all her bills (over $300k) and put enough away to pay the taxes and cover my schooling.

Oh, and the health insurance policy they had also jerked her doctors around so much she was unable to get vital medicines she needed in time, which I highly suspect lead to her death. Dad tried to pay for them himself, but honestly, when medicines cost over $4,000 a month to keep someone alive, and the insurance company decides it's going to throw you into appeals while they refuse to pay (in the end we had enough evidence to force them to pay up, but by then it was too late), how are you going to find the money?

They get away with this shiat because there are many who are too sick and too weak to fight for their rights. It's one thing to deny a person coverage because they're sick to start out with, but if a person has a plan with a company for X amount of time, then gets sick, the company is supposed to cover the expense.

If people knew that their premiums were no guarantee that services would be provided when needed, how many people would actually bother to sign up? If in big bold print it said at the top, "Premiums paid are not a guarantee that services will be provided," how many would go for it?

It wasn't as if she was sick because she was fat and lazy, or a drunk, or did stupid shiat. She was hit by a car while teaching me to ride a bike, a car that hopped the curb and was headed for me (mom suspected the guy was drunk). She actually launched herself off her bike and threw me out of the way of the car, and took the impact herself.

The asshole sped away after that too, never to be seen again. That accident lead to a whole slew of health problems caused by shoddy doctors and by the insurance company denying this or that medicine, basically saying, "Prove that you need it, and while you're doing that, you pay for everything. We'll review the bills after you're done in court, and we still might not bother to pay. Thanks for all those premiums, though!"

I don't mind that people who take gross risks with their health, or who flagrantly damage their bodies, or who don't take care of themselves, have issues getting coverage. Your duty is to take good care of yourself and be careful, and their duty (when paid) is to cover anything that happens that isn't your fault.

If some fatty wants to shove cupcakes into his face and chug beer, and gets diabetes, I'm all for him being denied coverage. If someone is born with an illness, or is hit by a car, or comes down with some horrible condition that no one could see coming, and that person is paying premiums month after month (or the person's parents are,) they should get the coverage they agreed to, and could have been expected to expect.

Most of those contracts have in there clauses that allow the insurer to just toss everything out the window if they want.

Whenever anyone asks you to sign a contract, you are limiting your rights, not having them protected. Just figure whenever anyone asks you to sign on the bottom line, they're covering their ass, not yours.

Oh, but you can modify the contract. That's OK. If they accept it with the modifications, it's all good. I did that with a gym membership I signed up for once. I crossed out all the sections that protected them from lawsuits by me if I was injured because they hadn't kept their machines in good condition (and dated and signed next to the modifications). I'm fine with, "If I injure myself because I'm being a dumbass, you're not liable," but I'm not cool with, "If I'm injured because you're not doing your job, you're not liable." Yes. Yes you are.

Healthcare is to life insurance as Unicorns are to pedo bears.

How long before we all just solve poverty and write each other checks for 100 gazillion dollars? This will also strike a blow to the evil corporations since we could then just buy them all and fire everyone. Or make them give their shiat away for free. Either way, we all win. Right?

farkin' Canadians. You people ought to stick to raping the earth. Leave business to adults.

El_Dan:I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

They are a private enterprise, not a charity.

Which is exactly why they should not be in the health care business.

Slugs_of_a_banana_nature:If some fatty wants to shove cupcakes into his face and chug beer, and gets diabetes, I'm all for him being denied coverage.

Way to ruin a powerful post with a blast of ignorance.

How many cupcakes are OK? How much beer? You do realize some people are much more prone to diabetes than others? Are other diseases to be subject to exclusions based on the 'self-abuse' clause? Does the burden of proof lie on the insured? How do we know someone _wasn't_ eating cake and beer every day?

How about: is it fair that people with no insurance usually pay 2-3x the amount for medical services and drugs, because they have no negotiating power?

I would have thought that someone who went through your experience would think these things through a little.

Temescal:"I raffled him off. I sold 500 hundred tickets at two dollars apiece and made a profit of $998."

What??

Churchill2004:El_Dan:I don't understand all this insurance company bashing. Like any private enterprise, the purpose of an insurance company is to make money for the shareholders. They do that by taking in as much money as possible, and spending as little money as possible. Contracts that include provisions allowing the denial of a payout, claims adjusters, refusals to insure unprofitable people, and similar devices are a natural byproduct.

They are a private enterprise, not a charity.

The problem is that insurance companies have a bunch of laws giving them special privileges and that destroy any semblance of market forces (aside from profit motive) on the insurance market.

Ah, yes, the spectre of "special privileges." That last little defense dipshiat libertarians claim when confronted with the fact that the profit motive doesn't cause businesses to act like charities.

The only way profit alone will motivate ethical behavior is if customers are free and willing to take business elsewhere. Even if "special privileges" did not exist, the insurance industry would come up with a collusive way to achieve the same result.

Insurance industry is the only industry I can think of that will fight you tooth and nail to deny the services that you paid for. It doesn't have to be fair or per their contracts, they just have to outlast you.

Don't forget these companies have whole staffs who worked full time to wiggle out of paying up, usually just by trying to trip you up in the red tape.

For instance, I'm still out thousands. One that disability pulled several times was "You must respond to this letter in two days" but it was postmarked three days later. "oops, you didn't respond in time - denied!"

I needed an expensive pain med that didn't have a generic. The prescription coverage company repeatedly lost the receipts or got things mixed up. I faxed them directly to a claim person and confirmed they had them by the phone more than once. "Sure, no problem, all is in order now". Oops, letters sent dated the next day, or even the same day, written by the same person I had just talked two saying they somehow don't have receipts after all. Denied!

I was literally spending 6-10 hours a day fighting this crap for the entire 3 months I was off work. But I could only do one full time job at a time, so once I went back to my regular job, I had to give up the fight. So for the duration I was mostly living on my savings which still haven't recovered.

For someone who wouldn't be able to fight it that hard themselves, they're just screwed.

Supposed to say:
For instance, I'm still out thousands for knee surgery.