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What are my rights under the Health Insurance Portability and Accountability Act ?
My 19 year old daughter, my only dependent, has been covered by my group health insurance policy all her life. She got pregnant last year and was unmarried. She carried the baby until the sixth month and lost it due to chromosomal abnormalities. That pregnancy was covered by my group insurance. She is now pregnant for a second time but has just informed me that she got married in February 2006. When I contacted my benefits office, I was told that I had missed the deadline for requesting a conversion policy for temporary coverage for my daughter and that there were no exceptions. This seems so harsh since she now has no coverage for this pregnancy. I am willing to pay the increased premiums back to the date of her marriage. I have continued to pay my family premiums and am not asking for a reimbursement. Do I have any rights under the federal law that requires a employer to allow a dependant to convert to an individual policy? Jan
HIPAA does not require that employers and insurers cover dependents at all, nor does HIPAA prevent a group plan from imposing an age restriction on dependents. So I don't see a HIPAA violation here. However, there may be several alternatives available to her:
1) Call your state's Children's Health Insurance Program (this is separate from Medicaid/Medical Assistance). All states administer this federally-funded program. Pregnant women are eligible to enroll.
2) Is your daughter working? She may be able to obtain insurance through her employer. Her pre-existing condition of pregnancy is protected under HIPAA. Note, though, that she cannot enroll outside of the open enrollment period.
3) Once your daughter's insurance termination is processed, the insurer must send her a form known as an "Evidence of Creditable Coverage" form. She can use this as proof of prior group coverage when purchasing her own individual policy. HOWEVER, she must do this within 63 days of the date her group coverage terminated. You don't state when that was, so I can't tell you whether she's still eligible for this.
4) Now that she's no longer on your group plan, she can enroll in the insurance offered through her husband's employment, provided that he's already enrolled. State laws differ regarding this issue, so you may want to call her state's insurance commissioner's office.
5) If she's financially eligible, she can enroll in Medical Assistance. Because she's married, it's not likely this will be available to her, but you can try.
I hope this helps. Send me a message through YA if you have any questions.
Insurance Premiums not Affected by Rise in Personal Injury Claims
Those paying monthly insurance premiums should not be affected by an increase in claims revealed an industry expert.
Colin Ettinger, president of the Association of Personal Injury Lawyers, said: “Whenever there has been an investigation into whether or not increases in insurance premiums have been down to rises in the number of claims the answer has always been no.”
He added that an investigation by the Department for Work and Pensions and the Office of Fair Trading came to the conclusion that hardening of the stock market has forced insurance companies to increase their premiums.
The Association of British Insurers (ABI) claim that the rise in premiums does not necessarily equal a rise in profits.
Jane Milne, of the ABI, said: “Certainly premiums have risen over the last few years but even in 2003 insurers paid out £1.10 for every pound they collected and we are still seeing claims costs rise between 12% and 15% a year.
“Forty pence of every pound that insurers payout goes to either legal or medical advisers.”
Small business are thought to be one group to feel the squeeze from growing numbers of claims.
Stephen Alambritis, of the Federation of Small Businesses, said: “There are a lot of cases of small businesses who are not taking risks, in terms of acting entrepreneurially, and employing people that they would normally take because of this problem.
“They are worried about these personal injury lawyers who incite people to take companies to court as they are often seen as a soft target.”
The ex- Lord Chancellor, Lord Falconer, also asked claims firms to refrain from encouraging the population from taking legal action for “frivolous claims”.
Mr Ettinger said: “Government information has shown that the levels of claims that have been brought forward in the last 12 months have actually dropped. That includes public liability as well as accidents at work and road traffic cases.”
He added: “I would like to say why don't these companies make their workplaces safer so a lot of these claims don't happen?”
A personal injury claim can made for a variety of reasons. These can include tripping over, car accidents, whiplash and work-related stress. In order to pursue a claim it has to be shown that whoever is being sued has acted negligently and the an injury resulted because of this carelessness.
There are two types of damages that can be claimed for: Special Damages and General Damages. Physical and mental injury come under the general damages category and they have to be proved by a medical examination.
Financial costs are included in special damages and include loss of earnings and expenses.
Following a medical examination and input from experts the opponents solicitors are contacted to see if they accept liability for the injury. A settlement is reached if they do and damages are paid.
The help of a solicitor is normally needed to guide the claimant through this procedure. When taking action for personal injury legal aid is not normally an option although many firms offer a 'no win no fee' kind of contract.
Claims rarely reach court and have to be started within three years of the injury occurring.
About the Author
Linsey is an author of several articles pertaining to No Win No Fee, Compensation Claims, Personal Injury Claims and other legal articles.
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