I read and copied the below as invited. I have been an insurance broker for over 43 years, so of course I have an opinion… lol
I am an insurance broker, Also I am a very highly paid insurance consultant, working with your legal team to explain insurance, and provide the third party proof and source material, while helping with strategy in support of your legal team. I do primarily work of defective construction issues, but also have consulted on auto losses, large Ag losses, professional liability, the more complex the better! If you can’t lose my commercial would be have your attorneys call me. 🙂
Most of my clients, and their attorneys at some point all ask the same question as we are working together. “How do you off hand” just know all these policies.
At a dinner once I was the entertainment for a dozen VP’s of a large national construction company as they would throw a “what if” at me, I would respond with the answer and where in the certain policy by the assigned form #, then quote the coverage. My children growing up use to call and say “hey dad where is that scripture about the degree of sin” or other such, and I would tell them, and they would hit me up with more as their friends would be amazed… I know two things very well. Scripture and Insurance.
How? I am disabled. I have dyslexia, so I can’t read or write as others do. I learned to site read and write. I memorize a word, how it looks, how to spell it and how to say it. Ask me to “read” a new word? I can’t sound it out. I have to memorize it.
What does all that matter?
Insurance claims are usually straight forward. But some complex issues are much like a rubix cube. One fact changes and it changes other things in the policy and coverages also. (which is why Dyslexia is a blessing, as I can see the whole of it)
This has grown over the years to the point I can simply remember what I read, and what I have been taught as well as the source.
I share this so I can say that treating any illness differently than any other illness by an insurance company is text book bad faith. Keeping in mind insurance is a unilateral contract of adhesion. Demanding the highest level of client care of all agreements. Does it seem to you that mental and addiction diseases are being treated as other diseases? Me neither!
The exception to that statement is “exception” and exception is a legal part of the policy which can add or limit or change coverage or how something is going to be handled. It has to be approved by the department of insurance. So if the insurance companies want to treat Addiction and Mental Health diseases differently as they are doing right now, they first would have to get state approval, which they haven’t and can’t get. Why? Because if it is a disease, which it is then they would have to have a reason that it should be treated differently than other Disease. Which they don’t.
What are punitive damages? We all seem to know they are penalties for intentional bad actions. In the insurance world it is called “Bad Faith”.
My 2 cents. I remember years back when mental health and addiction was classified as any other illness. To treat it as anything other than “any other illness” intentionally, and yes this is intentional. Makes this bad faith. Colluding together to all do the same thing?? Where is the DOJ on that one?
The trade off? Premiums would have to increase. The concept of insurance is to spread the risk among a large group of units. (People) . All rate increases also have to be approved.
In the end, medical insurance is going to have to pay for coverage as they should and our rates will have to increase to cover it. To cut health insurance premiums is a different conversation… which I am happy to share as well. It is almost too simple.. Why hasn’t it happened? Just simple greed. I can run it down line by line. But the summary will be greed.
Before the change, first we will see some very large Bad Faith claims and criminal prosecution.
Criminal prosecution? come on GW, how is that? just my opinion but I also believe insurance companies have colluded to act together for their financial benefit to the detriment of their policyholders.
So my opinion is someday we will see insurance companies pay large bad faith claims as well as face criminal charges for taking collective action against their policyholders, for their financial gain. Kind of like when the DOJ goes after the Mob, for rico violations. Interesting, both the mob and insurance carriers are killing innocent people for profit… This is just my opinion. That said, I think if I started to “dig into it” we would find I am more correct than not.
Ps. Most clients don’t know more than it is or isn’t covered getting their advice from the insurance company. Further bad faith and now we add unfair claims practices to it.
If you have a legal team already on this, I would be happy to help.
Below is copied as given permission. Feel free to copy and repost my entire post. Maybe it will help those suffering with mental illness and addiction disease?
In case you didn’t know….. worth the read please.
Did you know that addiction is classified in the DSM-5? It’s a mental illness that lives in the brain stem: the same brain stem that serves a critical role in regulating certain involuntary actions of the body, including heartbeat and breathing. Addicts feel that they need their drug of choice (DOC) the same way they feel they need to breathe.
Did you know that our society treats addiction as a moral issue and pawns it off on law enforcement to “control”? The average stay in jail being 365 days or less. Where addicts are left to detox alone ?
Did you know the detox process can be violent and result in death if not monitored by medical professionals?
Did you know the addict is many times released, and at that time, their serotonin levels are at their lowest, leading to a high crime rate and a higher chance in relapse. It’s a pun to say that this is criminal but that’s exactly what this really is ….criminal.
It takes an average of 14-16 months of sobriety for an addict’s brain to balance serotonin levels to that of a neuro-typical brain. Did you know that?
Did you know that most insurances will only pay for 30 days of treatment for an addict? Most times you’re lucky to get even 14 days!
Please get mad about that. I’m begging you …get mad about that.
Did you know that 136 people die everyday from opioid overdose? That’s one person every 10.58 minutes. By the time you’re done reading and processing this post, someone will have died from an opioid overdose.
Let that sink in.
Did you know that the two biggest factors that “make” an addict are
(1) Genetic Predisposition and (2) Childhood trauma. There’s not that “one hit” or that “one decision” that will make an addict. You never really know who is or is not an addict before they ever even pick up. It’s NOT a moral problem. I repeat, addiction is NOT A MORAL PROBLEM.
Just for a minute let’s take this in a little bit of a different direction. Did you know that the BRCA gene for breast cancer has a 5-10% genetic predisposition rate? People every day undergo testing and life changing surgeries to avoid it but addiction genetic predisposition is over 50%.
O V E R 5 0 %. Let that sink in.
You still think addiction is a moral problem? A parenting problem?
Too bad there isn’t a surgery to remove addiction huh ?
If there’s one thing an addict would say….it’s that they’re still in there. (I know because I’ve asked.) The person that you knew and loved is still in there.
They are not their disease.
THEY ARE NOT THEIR DISEASE.
Addiction is a disease. Much like diabetes. It has to be monitored everyday. For the rest of their lives. And it’s HARD. It takes support and unrelenting diligence. Like cancer in that it can always reoccur.
The blaming needs to stop. We need to do better.
The paradigm needs to change.
Insurance benefits needs to change.
Public awareness needs to change.
The next time you hear someone say “ they have a choice “ or you hear others refer to addicts as “ a junkie“ start by educating them because that really is how this works.
You can make a difference you can change things. It starts with educating yourself and then ￼spreading that knowledge one person at a time. Please I beg you join me in this.
Copied and pasted. Please do the same… Be a part of the change!