California could do more to investigate complaints against disability insurance providers, according to several legal experts, the Los Angeles Daily Journal reports.
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.
Other legal experts say that California officials could curb unfair claims denials by:
- Undertaking "market conduct exams" to scrutinize industry practices;
- Investigating complaints against disability insurers;
- Levying fines on insurers that unfairly deny claims;
- Prohibiting policies from including certain clauses that make it difficult for consumers to file legal action against the insurers; and
- Regulating physicians hired by insurers to support claims denials (George [1], Los Angeles Daily Journal, 11/20).
Advocates Call for ERISA Reform
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.
Advocates say the act makes it difficult for consumers to pursue legal recourse for claims denials (George [2], Los Angeles Daily Journal, 11/20).