Insurance Law Commons^™

Engaging Health Insurers In The War On Prescription Painkillers, Valarie K. Blake

Scholarly Works

While insurers have both the power and the motivation to curb the practice of harmful opioid prescribing, they may go about it in ways that could be counter-productive to larger public health goals. After all, insurers have historically discriminated against addiction like any other condition that leads to costly healthcare consumption. In the past, insurers have avoided enrolling addicted insureds and have limited rehabilitation services. To address this epidemic, insurers might engage in ways that could harm third parties. For example, to the extent they are permitted, insurers might avoid addicted enrollees altogether, or might limit coverage of addiction treatments …

Rethinking The Americans With Disabilities Act’S Insurance Safe Harbor, Valarie K. Blake

Scholarly Works

Despite the importance of access to healthcare for the disabled, the Americans with Disabilities Act (ADA) has made little inroads in reducing disability-based discrimination by health insurers in the United States. One reason is undoubtedly the ADA’s insurance safe harbor, which explicitly permits insurers to discriminate on the basis of disability in health insurance so long as the differential treatment is supported by actuarial data and is not just intended to disadvantage the disabled. While the safe harbor’s harms are somewhat limited by the advent of the Affordable Care Act (ACA), they are not entirely neutralized. This article argues that …

Agreeing In The Shadow Of The Policy: How Corporate Insurance Policies Impact The Resolution Of Governmental Investigations Into Corporate Crime, Beth Olsen

Connecticut Insurance Law Journal

No abstract provided.

Remedies For Breach Of The Pre-Contract Duty Of Disclosure In Chinese Insurance Law, Zhen Jing

Connecticut Insurance Law Journal

No abstract provided.

Teaching Health Law From A Social-Ecological Perspective, Lindsay Wiley

Scholarly Articles in Law Reviews & Journals

I started teaching health law relatively recently-in the fall of 2010, just after the Affordable Care Act ("ACA") was enacted, but before much of it had been implemented. This timing has been a blessing because I started with a fresh slate rather than adding the ACA on top of a previously developed course. It has also been a curse, but ultimately I appreciate that I started teaching the course at a time when the ACA was under constant threat. The ever-evolving nature of health law means that health law teachers must always bear in mind a goal that applies to …

Wearables And Personal Health Data: Putting A Premium On Your Privacy, Alexandra Troiano

Brooklyn Law Review

Recently, insurance companies have gained greater insight into their policyholders’ health habits by incentivizing them to take steps towards a healthier lifestyle through the use of wearable devices. This note addresses the recent trend of insurance companies that offer discounts to policyholders who use Fitbits, or other wearable wristbands, to track and report health information. At first glance, this idea seems like a win-win for insurance companies and policyholders–insurance companies can reduce risk by encouraging healthier habits for their policyholders, and policyholders receive discounts on their health insurance. Despite this synergy, however, this type of program threatens personal privacy, particularly …

Dead Or Alive? The Law, Policy, And Market Effects Of Legislation On Unclaimed Life Insurance Benefits, James M. Carson, Robert E. Hoyt, Tim R. Samples

Notre Dame Journal of Law, Ethics & Public Policy

A wave of multi-state audits on the insurance industry’s use of the Social Security Administration’s Death Master File (DMF) stirred national controversy over the status of unclaimed life insurance proceeds. Multi-state investigations uncovered “asymmetric” use of the DMF among many large insurance companies. Accusations of unethical behavior led to numerous settlement agreements between state regulators and insurers. Payouts and fines stemming from these settlements already number in the billions of dollars. Legislative responses are also underway. Some states have adopted—and others are considering—legislation requiring life insurers to search the DMF to identify and pay (or eascheat) unclaimed death benefits. Currently, …

Changing The Tax Code To Create Consumer-Driven Health Insurance Competition, Regina Herzlinger, Barak D. Richman

Faculty Scholarship

Because current tax laws exclude employer-paid health insurance premiums from employees’ taxable wages and income, employer-sponsored insurance remains the primary source of health insurance for most employed Americans. Economists have long blamed the employer-based insurance tax exclusion for inflating health care costs, and, more recently, for constraining income growth and exacerbating income inequality.

We execute a simulation to test the effect of permitting employees to receive their employers’ premium contribution directly and then purchase health insurance themselves, using tax-free funds. Employees could deduct for income tax purposes the amount used for insurance and, if they spend less than the amount …

N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice

Faculty Scholarship

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and citizens. It assesses …

Extra-Contractual Liability In The Restatement Of The Law, Liability Insurance: Breach Of The Duty To Settle Or Bad Faith?, Jeffrey E. Thomas

Faculty Works

This paper focuses on the Restatement’s treatment of an insurer’s duty to settle and the duty of an insurer to act in good faith in handling liability claims. The duty to settle is framed as an objective “duty to the insured to make reasonable settlement decisions.” At the same time, however, a separate claim is retained for an insurer’s “bad faith” breach of its duties (including the duty to settle). Further, a subjective element is adopted for the bad faith standard. To be liable for “bad faith,” an insurer must act “without a reasonable basis for its conduct” and must …

The Role Of Prejudice In Resolving Insurance Condition Clause Disputes: The Good; The Bad; The Ugly, Johnny Parker

Articles, Chapters in Books and Other Contributions to Scholarly Works

This Article examines the legal consequences that flow out of an insurance company’s denial of coverage based on an insured’s failure to comply with policy conditions. Specifically, this Article examines the various methods used by courts to strike a balance between the principle of freedom of contract and policy norms associated with resolving condition clause disputes. The pros and cons of the historical condition precedent vs. condition subsequent analysis and the modern day functional approach to contractual interpretation are dissected and discussed in the insurance contract context. The prejudice rule, which is associated with the functional approach to contract interpretation, …

Coverage In Transition: Considerations When Expanding Employer-Provided Health Coverage To Lgbti Employees And Beneficiaries, 24 Cardozo J. Equal Rts. & Soc. Just. 3 (2017), Kathryn J. Kennedy

UIC Law Open Access Faculty Scholarship

The rights of transgender individuals has been in the headlines during 2017 - ranging from President Trump's tweet to announce a ban on transgender individuals from serving in the military due to the "tremendous medical costs" to a nationwide injunction imposed by a federal district court on the HHS regulations that prohibit health-care discrimination against transgender individuals under the Affordable Care Act (ACA). There are three important reasons why transgender rights are in the news. First, the Human Rights Campaign Foundation, designed to promote the lives of lesbian, gay, bisexual, and transgender (LGBT) people, scores employers in its Corporate Equality …

Disparities In Private Health Insurance Coverage Of Skilled Care, Stacey A. Tovino

Faculty Articles

This article compares and contrasts public and private health insurance coverage of skilled medical rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, speech-language pathology, and skilled nursing services (collectively, skilled care). As background, prior scholars writing in this area have focused on Medicare coverage of skilled care and have challenged coverage determinations limiting Medicare coverage to beneficiaries who are able to demonstrate improvement in their conditions within a specific period of time (the Improvement Standard). By and large, these scholars have applauded the settlement agreement approved on 24 January 2013, by the U.S. District Court for the District of Vermont …

E/Insuring The Marijuana Industry, Francis J. Mootz Iii

University of the Pacific Law Review

No abstract provided.

Redefining Medical Care, Lauren R. Roth

Scholarly Works

President Donald J. Trump has said he will replace the Affordable Care Act (ACA) with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of “medical care” that can be reimbursed through an HSA are listed in § 213(d) of the Internal Revenue Code (Code) and include expenses “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.”

In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. …

Insurance Law, J. Price Collins, Blake H. Crawford, John C. Scott

SMU Annual Texas Survey

No abstract provided.

Remedying Stigma-Driven Health Disparities In Sexual Minorities, Valarie K. Blake

Law Faculty Scholarship

No abstract provided.

Consumer Financial Protection In Health Care, Erin C. Fuse Brown

Faculty Publications By Year

There are inadequate consumer protections from harmful medical billing practices that result in unavoidable, unexpected, and often financially devastating medical bills. The problem stems from the increasing costs shifting to patients in American health care and the inordinate complexity that makes health care transactions nearly impossible for consumers to navigate. A particularly outrageous example is the phenomenon of surprise medical bills, which refers to unanticipated and involuntary out-of-network bills in emergencies or from out-of-network providers at in-network facilities. Other damaging medical billing practices include the opaque and à la carte nature of medical bills, epitomized by added “facility fees,” as …

Murder For Life Insurance Money: Protecting The Children, Johnny C. Chriscoe

Scholarly Works

Children are being murdered for life insurance proceeds.

Of course, if a beneficiary murders a child for the recovery of life insurance money and if he is apprehended, he will surely face numerous legal consequences. He will not recover the insurance money, he will be prosecuted and likely sentenced to life imprisonment or execution, he may be sued for the wrongful death of the child and he may be prosecuted for insurance fraud. However, all of these legal responses are triggered by the death of the child and, therefore, do not serve to protect the child from being murdered in …

Regulation By Government-Sponsored Reinsurance In Catastrophe Management, Qihao He

Connecticut Insurance Law Journal

No abstract provided.