Does California Insurance Rate Hike Mean Anything for Denied Claims?

March 30, 2013, 1:30PM. By Heidi Turner

San Francisco, CACustomers who are already fed up with paying high California insurance rates while being denied disability insurance and other insurance claims are likely not happy to hear that rates for at least one insurer are set to increase. Regulators have criticized Blue Shield for its proposed rate hikes, which are no guarantee that more customers will have their insurance claims accepted.

The Los Angeles Times (3/7/13) notes that Blue Shield has announced it will increase its rates by up to 20 percent for approximately 268,000 individual policyholders (meaning those who purchased their own insurance rather than obtaining insurance through an employer), while another 27,000 policyholders will see increases of an average of almost 12 percent. One customer quoted in the article reported her monthly premiums would cost almost $700 a month. Although regulators criticized the rate hike, they have no authority to overrule premium changes.

Of course, these premium changes will likely not affect whether or not policyholders have their claims approved. Customers of many insurance companies argue that they have had their insurance claims denied for questionable reasons. They say they are given the runaround by companies, are asked to repeatedly submit the same paperwork and have payments unreasonably delayed.

In some cases, they say their claims are denied on the grounds they did not submit enough information or because an insurance doctor disagrees with the diagnosis of the patient’s doctor. In other cases, their claims are denied because of an error on their policy application or because the company claims the policyholder had a preexisting condition, even if that condition does not affect the claim.

California regulators reportedly took steps to protect consumers in the state, including measures to guarantee coverage for consumers even when they have a preexisting condition. The bills would also prevent discrimination on the part of insurers and prohibit overcharging customers.

No word on whether there would be tougher sanctions against insurance companies found to be practicing bad faith insurance. Customers with first-party insurance (also known as individual policies) have the ability to file a lawsuit as soon as their claim is rejected. Those who have third-party insurance through their employer must file an appeal first, and only after the appeal is rejected can they file a lawsuit.