Outten & Golden: Empowering Employees in the Workplace

Healthcare Insurers: I Think the Appropriate Word is "Disturbing"

August 14th, 2009 | Paul Secunda

Washington Post’s Daily Dose Blog adds more fuel to the health care reform debate:

You might have known that insurers can deny health coverage based on preexisting medical conditions, but here’s something else to worry about: They can take away the coverage you thought you had when actually need it, the government says.

The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.

“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals’ policies if any condition was not disclosed when the policy was obtained, “even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”

“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said.

The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims.
At least one insurer included such savings in an employee performance evaluation.

I teach a case in employee benefits law class, McGann v. H&H Music (5th Cir. 1992), that describes a similar practice to this. Unfortunately, the court in McGann found that the participant could not prevail under an ERISA Section 510 retaliation claim when his coverage was dramatically reduced (1 million to $5000) when he told his employer he had AIDS.

Maybe I’ll just start counting reasons why health care reform is a necessity and that health insurers cannot continue to exist in a world with little regulation and even less meaningful remedies against them for this type of disturbing conduct.

The employee performance part can be filed under “truly disturbing.”

Paul Secunda: Paul Secunda joined the Marquette University Law School as an associate professor of law in the summer of 2008. He teaches employment discrimination, employee benefits, labor law, employment law, civil procedure, and seminars in special education law, global issues in employee benefits, and public employment law. Professor Secunda is the author of nearly three dozen books, treatises, articles, and shorter writings. He is also the author, along with Rick Bales and Jeff Hirsch, of the treatise, Understanding Employment Law, along with Sam Estreicher and Rosalind Connor, of the case book, Global Issues in Employee Benefits Law, and of the Teacher’s Manual to the 14th Edition of the Cox, Bok, Gorman & Finkin Labor Law casebook.Professor Secunda is a frequent commentator on labor and employment law issues in the national media and has written numerous columns and op-eds for the National Law Journal and Legal Times. He co-edits with Rick Bales and Jeffrey Hirsch the Workplace Prof Blog, recently named one of the top law professor blogs in the country, which is part of the Law Professors Blog Network.

This article originally appeared on Workplace Prof Blog and is reprinted here with permission from the author.

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