a man standing in front of a door: The many confusions and disputes in COVID-19 insurance settlements


© Venkatasubramanian K
The many confusions and disputes in COVID-19 insurance settlements

Abhishek Bondia

“Make sure you assess your viral load based on the CT value,” Biocon’s Kiran Mazumdar Shaw suggested in her blog about ways to manage COVID-19 after successfully recovering from the illness. The Hindu was quick to declare shortly after Shaw’s blog was published that there is “no correlation between CT values and COVID-19 severity.” Such contradictions have been a hallmark of this evolving pandemic. Similar confusion has prevailed in several parts of insurance delivery. At times, this has compounded the issues for the policyholder, who is battling a relatively less understood illness, the social issues attached to it, and limited supply of proper care.

Confusion despite clarification

At the onset of the pandemic, the insurance regulator clarified that all standard health insurance policies cover COVID-19 and asked for insurers to be extremely cautious before rejecting a COVID-19 claim. However, several issues emerged despite such a broad clarification. Would hospital quarantine be covered under insurance, if you are not tested positive but suspected of COVID? Is a claim admissible if a COVID-positive patient is hospitalized to ensure the condition does not deteriorate, but the line of treatment is conservative? Insurance policies generally do not reimburse expenses incurred for observation purpose. If a patient chooses to be treated at home instead of getting hospitalized, would the expenses be reimbursed? In policyholders’ minds, home treatment leads to lower outgo for the insurer. So, they have a commercially rational expectation to have at least the reduced expenses reimbursed. But, in most policies, a minimum 24 hours of hospitalization is required for a claim to be accepted.

Scarcity premium

Scarcity of hospital beds, which resulted in price increases, has been another major source of customer dispute. Several hospitals have unilaterally increased

FILE - In this Jan. 24, 2018, file photo, Larry Nassar, a former doctor for USA Gymnastics and member of Michigan State's sports medicine staff, sits in court during his sentencing hearing in Lansing, Mich. MSU is defending itself against a second wave of lawsuits related to Nassar but says it wants to reach a deal with the additional assault victims. MSU defended itself in a court filing Monday, Aug. 26, 2019. It says it's immune to liability for Nassar's crimes, no matter how

Carlos Osorio/Associated Press

The U.S. Olympic and Paralympic Committee reportedly filed a lawsuit in a Colorado district court on Thursday against its insurance carriers, claiming they are delaying payments stemming from the Larry Nassar sexual abuse fallout.

Nancy Armour and Tom Schad of USA Today reported the news, noting the USOPC has not reached a settlement with the more than 500 girls and young women who sued the organization and USA Gymnastics because they said they were sexually abused by Nassar or others within the sport. 

Mediation has lasted approximately a year and a half, and USOPC said the 11 insurance companies it is using have “failed to honor their promises,” which has delayed any settlement payments.

“This lawsuit seeks to have a court resolve the issues related to the insurers’ obligations, as part of our efforts to achieve a fair resolution for the victims and survivors,” board chair Susanne Lyons said.

Armour and Schad explained the lawsuits filed by the survivors against USA Gymnastics and the USOPC were put on hold in December 2018 when USA Gymnastics filed for bankruptcy, but the organization must reach a settlement agreement or the lawsuits can resume.

As part of the lawsuit against the insurance carriers, the USOPC denied responsibility for Nassar and said it took out the insurance policies so it didn’t have to pay the claims to survivors and could continue funding other athletes.

Armour and Schad also noted on Aug. 24 the USOPC joined a joint motion filed on Aug. 20 by USA Gymnastics and the survivors that said the insurance carriers were stalling settlement negotiations “for their own economic benefit.” 

In 2018, Nassar, who was a former USA Gymnastics and Michigan State University physician, was sentenced to 40 and 175 years in prison.

A couple (Credit: Shutterstock)

Traditionally, life settlements – the sale of an unwanted or unaffordable life insurance policy for substantially more than the policy’s cash surrender value — have significantly benefitted seniors by providing them with resources to help pay for rising health care costs, medical bills and other needs in retirement.

(Related: Where the Life Settlement Business Is Now — And Where It’s Going)

For a policy to have value in a life settlement, the insured person under the policy typically needed to be in their mid-to-late 70s and have had a decline in health since the policy was first issued. Health impairments such as diabetes, heart disease, cancer or other serious medical conditions were often necessary in order for the policy to be sold.

But now, even healthy seniors – those whose health has not significantly declined from when they first took out the policy – have the option to sell their policies and generate income that can be used to invest in their retirement or pay for anticipated healthcare, long-term care, and other future expenses.

A healthy senior can qualify for a life settlement by meeting three criteria:

  1. The policy must be a guaranteed universal life (GUL) policy.
  2. The insured typically must be age 75 or older.
  3. The policy’s death benefit must be at least $250,000.

A policyowner who meets these criteria can receive an offer to purchase the policy without the need for a medical record review or underwriting. Offers to healthy seniors are usually made within 24 hours of receipt of the required information from the buyer.

This is good news for healthy seniors with GUL policies when compared to traditional life settlements. First, they wouldn’t typically even qualify for a life settlement. Second, traditional life settlement transactions take several months to complete because of the need

Having a automotive is an enormous accountability. I discussed briefly in my opening the truth that there are many alternative ways of achieving common healthcare. Employed, insured people also smoke and drink, and use unlawful medication, and apply unhealthy eating habits and suffer from a lack of enough train.

Common Health care should exchange the system presently held by Congress and the federal government workers. Though all lines of insurance brokers can launch a telemarketing campaign, this article goes to target the sale of individual health and life products.

The comprehensive intervention mannequin focuses on providing the highest quality of take care of every affected person by compiling information on quite a few methods and coverings; nevertheless with the present pressure to reform US health care and contain its costs, the mannequin must discover a approach to offer care whereas reducing prices.

You will need to note that it is believed that quite a lot of the fear people have regarding a single payer system is due to propaganda put forth both discreetly and overtly by healthcare insurance lobbying corporations whose employers would really like things to remain the best way they are.

Coordination of advantages is the best way that well being insurance companies ensure that overpayment doesn’t occur and subsequently purchasers can not revenue from double insurance policy coverage on one claim. For example, an organization organized underneath the laws of Canada and doing enterprise in the United States would be an Alien company in this country.…