The Texas Windstorm Insurance Association has voted to collect more money from insurance companies to bolster its reserves.  The vote comes on the heels of Hurricane Ike, which could cost the association $4 billion in claims.  There are also indications that a dispute between consumer groups in the state and the Texas Windstorm Insurance Association could be brewing, because of the association’s claim that its policies do not cover storm surge damage.

The Texas Windstorm Insurance Association is the insurer of last resort for 14 coastal counties in the state. The association covers  142,566 policies in the six Texas counties hardest hit by Ike.  The amount of claims paid through the association depends on how much of the damage is determined to be wind-related.  Texas Windstorm Insurance Association policies do not cover flooding and most other water damage.   (more…)

With refugees from Hurricane Ike returning to their homes to assess damage, insurance companies are bracing for an avalanche of claims.  Some experts estimate that Hurricane Ike could be the third most costly storm in U.S. history, behind Hurricanes Katrina and Andrew

When Hurricane Ike blasted ashore on September 13 as a Category 2 storm, it had sustained winds of 110 miles an hour, and a storm surge as high as 20 feet.  Many communities on the Texas Gulf Coast, including Houston and Galveston, sustained significant damage, and flooding was reported as far away as Mississippi.  Even as the storm weakened and moved inland, it was still a force to be reckoned with.  Damage from high winds and heavy rain was reported as far away as the Midwest and Ohio Valley. (more…)

Hurricane Gustav insurance claims could reach $10 billion, not as high as was first predicted when the then-Category 3 storm was churning in the Gulf of Mexico. Fortunately fears that Gustav would be a repeat of Hurricane Katrina – which cost insurers $41 billion – were not realized.

Hurricane Gustav came ashore the Louisiana Gulf Coast on Monday. Forecasters had feared that Gustav could come ashore as a catastrophic Category 4 storm, but the storm weakened to a Category 2 storm by the time it reached land. Damage from the storm’s winds and storm surge spanned from the Gulf Coast of Mississippi to Texas. Even after it weakened to a tropical storm, heavy rains and possible tornadoes spawned by Gustav’s heavy were expected to cause additional damage. (more…)

Amerigroup will pay $225 million to settle charges of Medicaid fraud, the U.S. Justice Department said on Thursday. A former Amerigroup employee, Cleveland Tyson, who filed the original lawsuit against the company, will receive $56.3 million of the settlement under federal whistleblower law.

The agreement reached with both the Justice Department and Illinois state officials settles allegations that the Amerigroup’s health plans illegally excluded pregnant women and unhealthy patients in the Illinois Medicaid plan. Medicaid is the state-federal health plan for the poor. (more…)

A class action lawsuit was recently filed in New Jersey charging that manufacturers of lawnmowers have purposely misstated horsepower valuations on their products in order to justify higher prices.   The lawnmower horsepower fraud class action lawsuit alleges that the major retailers and manufacturers of lawnmowers have conspired for the past decade to mislead consumers.

Defendants in the lawsuit include Sears & Roebuck Co., Briggs & Stratton, Deere & Co., Tecumseh Products Co., Briggs & Stratton Corp., Kawasaki Motors Corp. USA., MTD Products, The Toro Co., American Honda Motor Co., Electrolux Home Products, The Kohler Co., Platinum Equity LLC, and Husqvarna Outdoor Products. (more…)

An appeals court has upheld a bad faith insurance lawsuit verdict against the Allstate Insurance Co., leaving in place a $16 million verdict against the company.  Like the Missouri jury that originally found against Allstate, a three-judge appeals panel did not believe the insurance company’s assertion that its failure to settle the claims of two car accident victims in a timely manner was not intentional.

The Allstate lawsuit stemmed from a car accident that occurred in March of 2000, when a pickup truck driven by an intoxicated Wayne Davis Jr.  collided with the subcompact car carrying Edward Johnson and his wife, Virginia.  Both the Johnson’s survived, but their medical bills came to at least $320,000. (more…)

Americans who buy their own health insurance have very little protection if companies want to deny coverage or raise their premiums when they get sick. A new report published by the consumer advocacy group Families USA says states should do more to protect consumers from insurance companies that will stop at nothing to avoid paying claims.

About 14.5 million Americans bought their own insurance on the individual market in 2006.  The Families USA survey of insurance commissioners across the country showed that all but five states allow insurance companies to deny coverage to sick or older patients. All but 15 states have no limits on how much companies can raise premiums if individual policy holders. (more…)

A report just released this weekend by state Senator Jeffrey Klein (Democrat) reveals that some New York state HMOs restrict patient access to single source drugs or brand name medications for specific ailments that do not have lower cost generic versions.  The report includes a survey of the 15 HMOs with drug plans in New York state, including Aetna, Oxford Health Plans, Cigna, Health Insurance Plan of New York, Group Health Associates, and HealthNet of New York and was conducted to determine how and if companies restrict prescriptions to 20 of the most common single-source drugs.  The results point to HMOs setting these restrictions to increase their bottom lines and enhance profits.

The survey confirmed that a number of restrictions are placed on consumers, such as a “medical exception,” imposing quantity limits, and a “step therapy” rule.  A medical exception is when a patient and physician must obtain prior permission from the insurer so that a patient can receive coverage for a prescribed medication.  Medical exceptions are granted at the discretion of the insurance company.  Step therapy forces patients to try one or more other medications before seeking approval for a prescribed drug.  “It’s a dangerous situation,” Klein said.  “Clearly, when a doctor prescribes a specific medication for a patient and they know that drugs works for a patient, they shouldn’t be forced to use a generic drug or cheaper alternative that may not work,” he added. (more…)

State Farm Insurance has settled with more than a dozen policyholders who were suing the nation’s largest insurer over Hurricane Katrina damage claims.  The settlements were reached with plaintiffs who only last month learned that their lawyers had been barred from representing them because of ethics violations.

State Farm was one of the largest insurers on the Gulf Coast when Katrina made landfall there in 2005. Thousands of homes were reduced to rubble by wind and the massive storm surge created by the hurricane. Normal home owners policies do not cover damages from flooding, only wind. But in the case of Katrina claims, many home owners accused State Farm and other insurance companies of attributing damage to flooding, when in reality it was caused by wind, as a way to avoid paying the full value of claims. Some insurance companies initially made offers to settle claims for only pennies on the dollar, sparking thousands of lawsuits along the Gulf Coast. (more…)

Anthem Blue Cross is the latest insurer named in a lawsuit over illegally canceled policies.  The Los Angeles City Attorney is charging Anthem Blue Cross with deceptive practices and is seeking $1billion in restitution and penalties from the company.

Los Angeles City Attorney Rocky Delgadillo said Anthem, formerly Blue Cross of California, canceled policies and illegally denied claims when policy holders became ill.  In February, Delgadillo’s office filed a similar suit against Health Net Inc. for illegally canceling health insurance coverage for 1,600 customers. (more…)