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James Cool
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Lowenthal Goes After Loophole: New Bill May Prevent Some Insurance Companies From Breaking Promises

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Assemblywoman Bonnie Lowenthal is a state assembly member who introduced a bill on Monday that would make it more difficult for insurance companies to retroactively deny worker’s compensation claims. The bill, assembly bill 361, attacks a loophole in state law. The loophole currently allows for insurers to refuse payment for medical services and treatments that have already been approved. This is especially difficult for workers that are not able to return to work quickly – workers left to cover expenses that they were led to believe would be covered face additional hardship in recovering from an injury on the job. Will Shuck, Lowenthal’s chief of staff, explained that he was surprised at the current state of the law, and remarked that changing it was “about fairness.” He also stated that "What surprised Bonnie, me and everybody else, is that [the insurance companies] can say no [to payment after saying that they’ll cover it]." The lack of fairness is even clearer when comparing worker’s compensation coverage to coverage under a private insurance claim – private insurance companies are required to pay after telling an insured that their medical expenses will be taken care of. Many insureds rely on that, and reasonably so. There should be no less of an expectation when the compensation is owing due to a worker’s compensation claim. If the loophole is not closed, the approval that doctors are required to get from an insurance company before treatment is almost meaningless. Lowenthal captured this fact herself, stating: “if healthcare providers can’t rely on the pre-authorization system, there is little reason for having such a system in the first place.”

Currently, doctors call for approval…and they may get it to treat the worker…but then the worker may be stuck with the bill. In a time when worker’s compensation claims are on the rise, it is important that the loophole is closed and insurance companies are prevented from giving insureds the proverbial kick while they are down. Insureds have no reason to oppose the legislation, but it will be important that anyone who might someday wish to file for worker’s compensation support the bill. Even if you do not currently work or have a position that is eligible for workman’s compensation, it’s impossible to tell if you will be. Getting hurt at work always seems to be an outside chance. On the other hand, it may be easy for you to think of someone that has been hurt at work and had to file a worker’s compensation claim. Or may be facing that situation yourself. In either event, we are all invested in increasing protections for people, rather than allowing the insurance companies to step on the little guy as they reach for record profits…even in a recession. If you’d like to voice your support for this bill, please click on Lowenthal’s name at the beginning of this article and then the link that says “Contact Us” on the menu on the left hand side.