Doug Terry

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United Healthcare (“UHC”), the largest health insurance company in America, was found by the California Department of Insurance to have committed over 900,000 violations of California laws and regulations.  As a result, the California Insurance Commissioner imposed $173 million in fines.  UHC challenged the fines in court, and in early January the California Supreme Court upheld $91 million of those fines.  The remaining $82 million in fines are still pending on appeal. According to a…
I am happy to announce we obtained a $25.6 million verdict for our clients Ron and Orrana Cunningham this week in Judge Lisa Davis’ court in Oklahoma County.  The case is Cunningham v. Aetna, CJ-2015-2826.  It is a non-ERISA health insurance bad faith case.  I apologize for the length of this post, but I think this is a story worth telling.  I tried this case for 12 days with my former law partners, Justin Meek…
Insurance adjusters often don’t know how to properly interpret the language of the very insurance policies their companies sell their policyholders.  My experience tells me adjusters often read the insurance policy looking for any arguable as (even outlandish) way to deny coverage.  They take language out of context, misapply language to the facts of the claim and generally look harder for reasons to deny than for reasons to pay.  This is exactly the opposite of what…
A recent story in the Guardian reveals the statistics on how CEO pay at the largest US corporations has skyrocketed over the last few decades.  The Guardian story says in 1965, CEO pay was 20 times that of workers.  That would mean if a worker made $30,000.00 per year, the CEO would be making about $600,000.00.  However, today CEO pay has risen to an average of 312 times that of the average worker.  Therefore, if a worker…
When an insurance company receives a claim from its policyholder, the first thing the adjuster does is “check coverage.”  This means they verify the policy is in force by making sure the premiums have been paid and the policy period is in effect.  Then, the adjuster looks at the facts of the claim the policyholder is presenting to determine if the insurance policy language provides coverage for the claim. This may sound simple (and it…
There are many people working as claims professionals in the insurance business who strive to do the right thing by the company’s policyholders. When I run into one of them, it is like a breath of fresh air. These folks seem to genuinely care about policyholders and work hard to try to find ways to pay claims. They do not relish denying a policyholder’s claim and do not feel as though they have “won” somehow by denying a claim.…
Insurance companies often hire an “expert”  as part of their investigation of a policyholder’s claim.  The expert can be a doctor, an engineer, an accident reconstructionist, an accountant, etc. , depending on the type of claim and the issue being investigated.  Insurance companies and their lawyers love nothing better than to claim that because they hired and relied on an expert before denying the claim, they cannot be in bad faith.  They use the old…
In an excellent recent article in the New York Times,  a claim-handling practice by Anthem Blue Cross Blue Shield was brought into the public light.  Anthem has begun denying its policyholders’ claims for coverage for emergency room visits if Anthem determines after the fact that the policyholder didn’t really need to go to the emergency room in the first place.  Anthem is basing these decisions on what the final diagnosis of the policyholder’s condition turns…
CNN’s Wayne Drash (@drashmanCNN) has written a series of gut-wrenching, infuriating and telling stories recently regarding the health insurance industry’s treatment of policyholders.  They illustrate how profit is a more powerful motivator to the health insurance industry that policyholders.  Anyone interested in this issue specifically or responsible corporate behavior in general should take a look at Mr. Drash’s work. In the most recent of these stories, Mr. Drash tells the story of Erika Zak, a…
When you make a health insurance claim, oftentimes your health insurance company will have a doctor employed by the company review the claim to see if it should be paid. The problem I have seen in a number of cases is the doctors reviewing policyholders’ claims are horribly unqualified to make fair decisions on those claims. For instance, if you make a health insurance claim for payment of medical treatment involving your heart, you would…