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View Diary: Urgency of public option: BC/BS sued for engaging in "life threatening business practices" (271 comments)

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  •  another frivolous lawsuit - I fear (6+ / 0-)

     that will be tossed due to ERISA preemption or quasi governmental immunity invocations or some other wonderful creation by our activist judiciary.

     Many of us - long ago started screaming that the courts were out of control.  During that age it was so called "liberal" judges - Warren and Powell and Brenna that concocted these weird formulae to protect large corporations.  If you could stomach it - you might check into Pilot Life v. Deadeaux and its progeny.

     Now the iron boot of the corporate owned Republican  judiciary belches out all these immunities for truly egregious behaviour.  Republicans have made so called liberals look like toddlers in the world of protections and immunities and privileges for wrongdoing big corporations.  

     Oh well, if there is one truth I have found it is that everyone thinks that being the victim of this kind of wanton disregard only happens to the other guy and that if it does happen to you - well - your acquisence to the destruction of our remedies at law will not bar your lawsuit - guess what - it is too late - they have got you -

    •  Don't know if ERISA will protect BC/BS (5+ / 0-)

      in this case, I thought it prevented private people from suing.

      Does ERISA also prevents institutions from suing especially if their patients are facing death at the hands of this murderous industry?

      •  yeah - catch this logic - your head will explode (7+ / 0-)

         The Employee Retirement and Income Security Act ("ERISA")  contains provisions that deal with health care plans provided as compensation in what are known as ERISA plans:  employer provided benefit plans.   Some language in ERISA supposedly "preempts" all other state and federal causes of action for any plan that might be brought within the parameters of these employee health plans - so that the field is "completely preempted".

         The upshot is that if some of the patients for whom benefits are being denied access their plan through an ERISA benefit plan (which is most employer plans - their lawyers set it up that way - the plans can promise the moon and then preemption takes it all away) then the court may find preemption and pooooof goes the lawsuit (all in some quiet unremarked hearing.)

         This is what is happening every day in courts throughout our land - do not ask for whom the bell tolls.....

      •  ERISA originally passed as protection of (4+ / 0-)

        employee salary in event of illness, has been over the last twenty years, amended to death by the disability insurance industry.  It is now almost an insurance protection law.

        If a disability insurer "arbitrarily and capriciously" denies continued benefits a person may sue.  It is not allowed in a jury trial.  Only an administrative law judge reviews the "Administrative Record" which is larded with as many documents as the insurer can find to place before the hearing cut off date.  They often send private detectives to communities where the insured lives, to their house, and neighbors to see if they can catch the disabled person doing something that would allow them to cut off disability.

        One of the nice kickers is that the "independent medical person" reviewing the case for the disability insurance company is often the corporate medical director.  No conflict of interest said Justice Scalia, because it is under a long defunct and obscure set of justice called "Equity Law".  He resurrected laws struck down in the 1930's.

        If by some great force, an insured is restored to disability: - there is no remedy for the number of months or years the insured was without payment. - the check comes as a lump sum and puts that year's income in a higher bracket. - there is little to no reimbursement for legal fees, time spent assembling the case and other expenses. - there is no remedy for any harm that may have occurred, meaning, the insurer cannot be sued for anything that denial of benefits caused. - the insurer will continue to deny disability payments until a suit is filed.  It is the only way to get them to stop. - the insurer is not penalized in any way for going beyond deadlines for response to denials, usually 90 or 120 days.

        These so called protections apply to group plans that are offered usually by employers, located in more than one state.  The state insurance commission cannot intervene in these situations.

        Yes to the comment below Boxer7.

        Thank you all.

        ERISA needs to be completely rewritten or gotten rid of.

        I'm new here; lurking since before '08 election. I'll try to find something pithy from William Wilburforce.

        by Regina in a Sears Kit House on Thu Jul 23, 2009 at 05:18:30 PM PDT

        [ Parent ]

        •  Thank you, Regina (1+ / 0-)
          Recommended by:
          Charles CurtisStanley

          You just gave me a heads-up that apparently is much needed. I didn't know SSDI benefits were taxable, but your comment caused me to go looking, and sure enough. If your income is high enough (starting at $25,000) you'll pay tax on up to 85% of benefits.

          I know I am qualified for SSDI; it's a matter of finding out how far back they're going to go. We had the hearing already and I am qualified for certain from March '07 on. The lawyer will get a percentage, defined in law, of my back award, and I get the rest; so this definitely applies to me, and possibly as soon as this year.

          Thank you very much for this public service.

          Want to be a living kidney donor? I need one from someone with a bloodtype of B or O. Drop a note at riverheart.livejournal.com.

          by Kitsap River on Thu Jul 23, 2009 at 09:46:07 PM PDT

          [ Parent ]

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