Having a Horse in the Race

Nearly a year ago, I found myself hunting for health insurance coverage because my husband, the primary policyholder on a family health policy, lost his coverage and we were forced to join COBRA -- the high risk pool that charges an arm and a leg for health coverage.

I must have filled out ten applications. Each application asked for details on previous medical claims filed by family members and contact information for each treating physician. I had no choice but to provide that information.

Needless to say, we were denied. What's interesting though is the reason for denial. In writing, I was told the reason for denial was because of the risks of additional short-term and long-term health problems due to exposure of toxic mold. Clearly, these health insurers know the potential adverse health effects of exposure, as evidenced by their refusal to incur such a risk.

In sharp contrast are the property and casualty insurers. These carriers, because of suits and claims pending against them because of water damage claims turned toxic mold claims and personal injury claims, are denying any health effects arising out of a toxic mold exposure. In sworn testimony, carriers and their medical experts claim that there is no causal connection between toxic mold and personal injury. I assume they must take this position because otherwise, they would be found responsible for their bad faith employed in the claims handling of water damage.

Toxic mold is an outgrowth of water damage. If water damage is left to fester, toxic molds will grow and quickly become airborne and contaminate the entire structure and everything inside. Toxic mold can enter the body via inhalation, ingestion and skin pores.

The vast majority of toxic mold claims arise out of delays and insufficient repairs as adjusted by the insurance company. In many cases, bad faith and breach of contract cases are filed against insurers who employ these common practices. If medical evidence is allowed to be presented, the insurer often is held responsible for the personal injuries suffered by the homeowner and his/her family. The health problems can vary from asthma and neurological damage to cancer and death.

Property and casualty companies have vigorously fought these cases and have taken a hard line position on medical evidence. They whine that not enough epidemiological evidence is available to prove personal injuries.

Yet, their colleagues in health coverage feel differently, even within an insurance company.

I know of one case in which the insurer offers both health and homeowners' insurance coverage. The staff assessing health coverage refuse to write policies for people exposed to toxic mold because "of the profound health effects suffered because of exposure" while the lawyers defending a suit against the same insurer whose delays and bad faith adjusting a property claim lead to a toxic mold infestation of the customer's home and consequential personal injuries, insist "There is no connection between toxic mold exposure and any health effects." Obviously, the two sides of the same house need to compare notes and get their stories straight.

Health insurance providers will ultimately suffer the financial consequences of the bad behavior employed by the property and casualty insurers because of the enormously expensive tests and treatments required by patients exposed to toxic molds. At a minimum, CT Scans, MRIs, extensive blood tests and lengthy treatments are required. The medical treatments for my family topped $110,000 for a two year period. Others polled have filed medical claims in excess of $450,000 during the same two year period. And, the tests and treatments continue far longer than two years.

Medical carriers have a horse in this race. The outcome will clearly impact their financial stability. They should not allow a lopsided game of hot potato to be played at their expense.

Check here to read each editorial. New editorials are added frequently so be sure to visit this section often.

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Avoiding Self-Inflicted Claim Wounds

12/5/03
SOLUTIONS FOR HEALTHIER BUILDINGS AVOIDING WINDOW AND DOOR LEAKS

11/19/03
THE RATE GAME: A STACKED DECK AGAINST THE POLICYHOLDER.

9/26/03
Tort Reform: Dead presidents are reason enough to keep the ball up in the air.

7/21/03
Did Republicans Put Their Eggs in the Wrong Basket?

3/3/03
The Goose and the Gander

11/5/02
LET 'EM GO!

8/19/02
Yeah. That's it. Let's Blame it All on the Lawyers.

7/9/02
REFORMING TORT REFORM:
Three Strikes; You're Out

6/19/02
WANT LOWER INSURANCE RATES?
Federal Mold Bill is the Answer 

5/31/02
What's In A Name

5/6/02
ONE MAN’S GARBAGE IS ANOTHER MAN’S GOLD

4/22/02
TOXIC MOLD: The Best Thing To Hit Insurance In Years  

3/12/2002
Insurance: Another ENRON?

2/27/2002
Having a Horse in the Race

2/20/2002:
The Forest and the Trees

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