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Life Health > Health Insurance > Life Insurance Strategies

California Patients Sue WellPoint

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A lawyer has filed 10 lawsuits alleging that units of WellPoint Inc. have made overly aggressive efforts to rescind the coverage of insureds who file medical claims.

William Shernoff of Shernoff, Bidart & Darras L.L.P., Claremont, Calif., says he has filed the suits on behalf of the plaintiffs in state courts in Los Angeles, Orange, Riverside and San Bernadino counties.

The suits name Blue Cross of California and Blue Cross Life and Health Insurance Company as defendants. The suits also name WellPoint Health Networks Inc. The current WellPoint Inc., Indianapolis, acquired WellPoint Health through a November 2004 merger.

The plaintiffs in the California suits have alleged that the California Blue and Blue Cross Life maintain a division that compares 10 years of patients’ prior medical history with claimants’ applications to find evidence that can be used to rescind the claimants’ coverage.

WellPoint does not comment on specific lawsuits, but Robert Alaniz, a company spokesman, says the company has a responsibility to review all claims carefully to make sure that the claims are valid.

California, like other states, permits insurers to rescind policies issued to consumers who have lied on their applications.

The plaintiffs in the 10 California cases say California Blue and Blue Cross Life have used responses to a confusing, overly broad application to violate state laws prohibiting “post-claim underwriting.”

California law “prohibits a health insurer from rescinding or modifying its authorization of services or treatment after the provider renders such service or treatment in good faith pursuant to the authorization,” according to the complaint filed in one case, Foiles vs. WellPoint et al.

The California Blue and Blue Cross Life application reviewers looked for any discrepancies between applications and medical records as opportunities to rescind policies, Shernoff says.

Shernoff cites one case involving a 46-year-old woman whose coverage was rescinded because she failed to disclose a case of hepatitis experienced as a child, although her current claim involved breast cancer.

California Insurance Commissioner John Garamendi and other state officials already are calling to ask about the suits, Shernoff says.

WellPoint will cooperate with any requests from regulators for information, Alaniz says.


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