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PROMPT-PAY INSURANCE LAWS A CONTINUING "HOTBED OF ACTIVITY"
Errol J. King, Esq. With 49 states and the District of Columbia now having enacted prompt-pay insurance laws, mostly applicable to the payment of the claims of health care providers, enforcement of the laws by regulators and legal action by providers against health plans continues to be a "hotbed of activity" across the nation. According to a survey of state medical societies, payment problems consistently top the list of complaints from physicians and hospitals. Meanwhile, regulators have stepped-up enforcement actions against health plans under state prompt-pay laws and plaintiffs are asserting tried and used, as well as new, causes of action nationwide. This article will identify the types of state laws that are found from state-to-state regarding the prompt payment of health care claims. This article will also discuss recent enforcement actions by regulators, causes of action being asserted by plaintiffs against insurers and defenses to provider prompt-pay lawsuits.
THE POLICY DEBATE ON GOVERNMENT SPONSORED HEALTH CARE REINSURANCE MECHANISMS
Robert M. Ferm, Esq. Recently many states have explored the idea of creating reinsurance programs to reduce costs of health care coverage for the "working poor" and small businesses and thereby reduce the number of individuals without medical coverage. The principle supporting government backed reinsurance programs is to allow insurers to reduce the excess reserves and surplus that they must hold, and subsequently build into premiums, in order to protect against exceptionally large claims. Although less than one percent of the U.S. population has annual medical expenses above $50,000, those individuals account for roughly 28 percent of the country's medical spending. Consequently, proponents argue reinsurance programs that either spread the risk or assume part of the risk can have a large impact on premium levels. However, structuring and implementing a program in an individual state raises myriad issues and obstacles.
IT'S THE END OF THE WORLD AS WE KNOW IT ... AND I FEEL FINE
J. Michael Low, Esq. Liability waivers and pre-accident releases are everywhere. Come to Arizona to play golf ….. sign a waiver for snakebites and errant drivers (both carts and golf balls). Want to take an aerial tour of the Grand Canyon … sign a waiver. Indeed, businesses—particularly the recreational tourism industry which is forming an ever-growing percentage of Arizona's economy—often ask customers to sign a waiver before engaging in any activity that may involve some risk of injury. The purpose of these waivers is twofold: (1) to inform customers about the potential risks of a particular activity, and (2) to show that the customer understand and voluntarily assumes those risks. The big question, however, is whether these liability waivers are enforceable? As usual, the lawyer's answer is: maybe.
SMALL GROUP POOLS: IOWA AND ELSEWHERE
John C. Schachterle, Esq. There is considerable discussion at the state and national level regarding the rising costs of health insurance, particularly for the small group market. One of the most discussed options to resolve this problem has been the presentation of creating large pools which proponents believe will help the situation. This article is intended to look at that issue and provide some discussion points.
THE "NEW" PERMANENCY STANDARD UNDER NEW JERSEY'S AUTOMOBILE INSURANCE COST REDUCTION ACT
Susan Stryker, Esq. In a continuing effort to balance the need for affordable insurance with the need to provide adequate compensation to tort victims, New Jersey's private passenger automobile insurance system has continued to evolve since the adoption of the no-fault statute in 1972. To this end, in 1988, New Jersey's legislature first provided drivers with the choice of opting to pay lower premiums in exchange for restricting the types of injuries for which a tort action may be brought. In order to reduce the skyrocketing costs associated with automobile insurance and reduce rates, in 1998 the State legislature adopted the Automobile Insurance Cost Reduction Act ("AICRA"). Among other things, AICRA further restricted the right to sue for non-economic damages for those New Jersey drivers choosing the "limitation on lawsuit" or "verbal threshold" option. In exchange, insureds choosing the option receive significant premium savings on their automobile insurance policies.
BERMUDA - A MODEL FOR SUCCESSFUL INSURANCE REGULATION
Kimberly A. Yelkin, Esq. Once thought of as solely a jurisdiction for captives, reinsurance and the alternative risk market, Bermuda has developed into the world's most successful and competitive insurance marketplace with significant insurance and reinsurance markets. It is targeted as a growth area by very large players who operate in all major insurance markets and write all classes of business. Bermuda has become a frontrunner in developing innovative ideas to address many of the insurance problems which face business today.
The FORC Journal is designed to provide practical and useful information, but not legal advice. If legal advice is required, please seek professional counsel. FORC does not endorse the views expressed in any of the articles contained in the FORC Journal.
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