May 26, 2017

Blue Shield of California Takes Another Rescission Hit


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11/17/2008
Brian S. King
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Blue Shield of California got more bad news in the on-going battle to defend its rescission practices in the golden state. You can read about it here in the L.A. Times. A couple of days ago an intermediate level state appeals court ruled that in order to justify rescission, Blue Shield of California must show that the applicant willfully misrepresented his health history. In the alternative, the ruling requires an insurer to demonstrate that they made "reasonable efforts" to ensure the applicant's statements were accurate and complete when they insurer initially evaluated the application. The case is Hailey v. California Physician's Service (d/b/a Blue Shield of California). You can find a copy of the decision at the court's website here. The decision reverses a trial court ruling in favor of Blue Shield. A measure of the importance of this battle to both sides in the argument is reflected by the number of amicus briefs submitted on support of each party.

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1 Comments to "Blue Shield of California Takes Another Rescission Hit"

Brian:
Thanks so much for keeping us posted on this important event in California.
Actually, I find much fault on both sides.
First, Cindy Hailey knew that coverage extended to everyone in the family.
She did provide the husband's height and weight, although the weight was very inaccurate.
In my opinion, it is not reasonable to assume that the other medical questions did not apply to every member of the family.
If Mrs. Hailey assumed that she was the only one that had to medically qualify, and the rest were guaranteed acceptance, then that is an unreasonable assumption, in my opinion.
On the other hand, Blue Shield of California was not allowed to perform post-claims underwriting.
Admittedly, it may be difficult to determine the extent to which they did, indeed, underwrite.
According to the case, if I understand correctly, no medical history was given for the husband and the children.
It is unreasonable, in my opinion, for the insurer to assume that no medical history existed for the balance of the family, and the insurer should have inquired at that time.
I find it extremely interesting that Blue Shield may have intentionally not responded to the husband's reported medical condition in 2001, because the claim did not justify investigating further.
Only when the future claim exceeded the premiums paid, did Blue Shield get nervous.
I had no idea this behavior occurred at the insurer level.
Don Levit
Posted by Don Levit on November 17, 2008 at 01:47 PM

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