We’ve previously blogged about the Mental Health Parity Act. This law forbids insurers from discriminating against mental health and substance addiction by covering treatment for those conditions less favorably than other medical treatment. A 2022 report noted insurers continue to violate this law. A new Washington Supreme Court ruling restricts individuals’ ability to enforce this law. On December 21, 2023, the court ruled in P.E.L. v. Premera Blue Cross that the plaintiffs could not sue their health insurer for excluding certain mental health treatment. In that case, two parents sued Premera ..read more

In 2007, Washington voters approved the Insurance Fair Conduct Act (“IFCA”). IFCA gives people recourse if their insurance company unreasonably refuses to pay their insurance claim. Recourse under IFCA includes important relief that consumers couldn’t previously get, including punitive damages up to three times the amount of their loss and attorneys’ fees. This was considered a big deal. Insurers, naturally, have urged courts to read IFCA narrowly. Like any new statute, judges applying it in the first instance have to consider how the language approved by the voters applies to the facts of par ..read more

You might think the question “what is insurance” is an obvious one. Most Americans probably understand, basically, that insurance is the thing where you pay somebody today and, if something bad happens tomorrow, they pay you. Health, auto and life insurance are universal enough that most folks have an intuitive understanding of them. But whether something is insurance can be less straightforward out of those common contexts. We’ve previously blogged about this question. That discussion came up in the context of “health sharing ministries,” where members of the same church agree to pool funds i ..read more

ERISA doesn’t just protect the right to receive your benefits under the company benefit plan. It also prohibits your employer from retaliating against you or interfering with your claims for those benefits. A recent decision from the Third Circuit Court of Appeals (the federal appellate court that hears appeals from Pennsylvania and its neighboring states in the mid-Atlantic region) has an interesting illustration of ERISA’s protections from retaliation. Although the decision, Kairys v. Southern Pines Trucking, Inc., isn’t binding precedent on courts in Washington State, it’s still a useful ap ..read more

Insurers are fleeing markets and raising rates to compensate for increased disaster losses. Farmers recently stopped insuring homes in Florida. This will result in cancelation of about 100,000 policies as those policies expire. Insurers are also withdrawing from California and Louisiana. These states have a lot of differences, but they share one thing in common: increased natural disasters attributed to climate change. Warming oceans have been blamed for increasingly bad hurricane seasons in Florida and Louisiana. In 2022, 42 percent of Florida insurance claims were hurricane-related. In Calif ..read more

Calculating earnings can be really important to disability insurance. Most disability insurance policies define “disability” in relation to how much the insured earned before they became disabled. For instance, a policy might say “we will pay you the insurance benefits if an injury keeps you from being able to earn 60% of what you earned while healthy.” And a person’s earnings often determine the amount of insurance benefits. Many disability policies will pay a person who become disabled a certain percentage of what they earned while working. Calculating these amounts is simple where a person ..read more

Washington State recently implemented model legislation from the National Association of Insurance Commissioners that regulates pet insurance. Pet insurance is a relatively new product that has grown in popularity with the increasing prevalence of pet ownership in the United States. Industry statistics reflect an increase of over 2 million in the number of pets insured nationally since 2017. Unfortunately, this emerging product line has been riddled with complaints of unfair business practices. Policyholders complain of insurers misrepresenting coverages, hiding exclusions, and failing to pay ..read more

We previously blogged about the WA Cares Act, a law creating a public long term care benefit for certain Washington employees. Under the law, employees pay a payroll tax in exchange for access to future long term care payments. Employees could opt out of the law by obtaining private long term care insurance coverage. The deadline to opt out expired December 31, 2022. A federal court largely dismissed a lawsuit challenging the act in 2022, theoretically clearing the way for the law to go into effect. But the Washington State legislature put the law on hold while it made some changes. The law so ..read more

If you were to poll the public on why lawyers or the legal system get a bad rap, the experience of getting surprised by something sneaky the other party buried in the fine print might rank high on the list. That was the outcome in Haddad v. SMG Long Term Disability Plan, decided February 10, 2023. There, the Ninth Circuit ruled that an ERISA plan could reduce a former employee’s benefit payments based on inconspicuous language hidden in the benefit plan documents. Mr. Haddad, like many folks, had long-term disability coverage through his employer’s benefit plan. He became disabled and the plan ..read more

Stop me if you’ve heard this one before: an old-economy business gets sold an AI or computer algorithm promising to cut costs and improve business. Innovation! Big Data! Progress! What could go wrong? Unfortunately, we’re increasingly learning that AI incorporates the same biases, including racial biases, that have always existed, except that it makes those biases harder to challenge by wrapping them in a shiny package of technological legitimacy. Allegations that AI and computer algorithms are used to perpetuate racial biases are nothing new. But a recent lawsuit indicates these practices are ..read more