Insurance Claims

The Obama administration's new plan to stimulate refinancings of FHA mortgages is likely to help large numbers of homeowners — even those who are deeply underwater — cut their monthly costs by switching to a loan with a rate below 4%. Here's a quick overview of the "streamline refi" program and what it will take for you to qualify. First, the baseline criteria: Your current home loan must be FHA-insured and must have been put on the Federal Housing Administration's books no later than May 31, 2009.

Nobody wants to get into a fight with a health insurer, but it may be worth your while. A recent Government Accountability Office report found that more claims problems stemmed from annoying but often straightforward billing and eligibility issues than from disagreements over whether care was medically appropriate. What's more, the odds are about 50/50 that if you appeal an insurer's decision, you'll win. When Natasha Friedus's son, Nofi, was born almost two years ago, her insurer refused to pay $1,500 of Friedus's $7,500 hospital bill because she hadn't gotten prior authorization for the hospital stay near her home in Seattle.

Re "Justice Served at Courthouse," July 7. It is no surprise Los Angeles County was required to sue its insurers to obtain payment for losses suffered (in the Northridge earthquake) to the San Fernando Courthouse. The largest area of insurance fraud is the fraud perpetrated by insurance companies in refusing to pay claims which they know are legitimate. If an entity as powerful as Los Angeles County has to resort to litigation, what chance does the average person have against the insurers that hold the checkbook?

For days on end, 23-year-old Hiraku Sato and a co-worker toiled in their pharmacy in Tagajo City, picking through hundreds of small containers of vitamin drinks, aspirin and other medicines that were flung to the four corners of their shop when ocean waters from nearly a mile away rushed in. A 4-foot-high mound of metal shelves, broken computers and other retail detritus was still massed this week outside the store in the northeastern coastal community....

Former U.S. Secretary of State Lawrence S. Eagleburger has backed down from a threat to resign as chairman of talks on compensating Holocaust survivors for unpaid life insurance claims after negotiators agreed to extend the deadline for accepting claims, participants said. The European insurance firms and Jewish groups participating in the talks have been at odds over a number of issues.

If past history is any measure, many homeowners affected by the wildfires burning throughout Southern California will find that claims they submit to insurers will result in higher rates or even dropped policies. What they, and you, may not know is that virtually all such claims also will end up in vast, privately run databases that are routinely accessed by the insurance industry to determine what rates they'll charge -- or if they'll cover you at all.

Question: I live in a condominium in Los Angeles that has 42 units. Our condo suffered damage because of common area problems. The board told us the insurance company requires originals and to give them all our receipts and documents relating to our claim and they would handle it. After ignoring our calls and letters for seven months, the board told us they or the management company lost all our evidence.

The Jewish Federation will hold a meeting tonight in the Fairfax district to discuss proposed legislation that would allow Holocaust survivors and their heirs to sue insurance companies for unpaid claims in California courts. The bill, sponsored by Assemblyman Wally Knox (D-Los Angeles), would also waive the statute of limitation for insurance policies that were issued to Holocaust victims and survivors, said Knox spokeswoman Colleen Beamish.

The final chapter was written Thursday in the 1982 bankruptcy of Tarzana-based American Benefits Ltd.--and it may mean a happy ending at last for several thousand workers still holding unpaid health insurance claims. Lawrence A. Diamant, the Los Angeles attorney who supervised liquidation of the company, announced a tentative settlement of $2.

A court order to liquidate the bankrupt Coastal Insurance Co. was issued Monday by a Los Angeles judge, clearing the way, after more than a month, for claims against Coastal's 200,000 California auto insurance policies to be honored by a state-appointed guarantee association. The director of the California Insurance Guarantee Assn., John W.

Descendants of Armenian victims of genocide at the hands of Ottoman Turks can sue insurance companies for unpaid claims over the atrocities, a federal appeals court ruled Friday in a rare reversal. The same three-judge panel of the U.S. 9th Circuit Court of Appeals said in August 2009 that lawsuits were barred by a federal government policy against legal reference to the Armenian genocide despite laws in California and 41 other states recognizing the massacre of 1.2 million Armenians that began in 1915 amid the chaotic collapse of the Ottoman Empire.

Two Los Angeles police officers were charged Monday with insurance fraud stemming from a case in which one of them allegedly had his car torched and the other helped cover up the crime, the Los Angeles County district attorney's office announced. Anthony Robert Villanueva, 24, allegedly arranged to have his 2001 Lexus sedan taken to the desert and set on fire in April. He then reported the car stolen and submitted a claim with his insurance company to be reimbursed, authorities alleged.

Allstate Corp. has sued Toyota Motor Corp. over sudden-acceleration-related claims it has paid, alleging that the accidents were caused by vehicle defects. The suit, filed Friday in Los Angeles County Superior Court, seeks $3 million in compensation for about 270 claims that the insurance giant has paid out since January 2007. It charges that "certain of Toyota's cars and trucks have a defect that causes sudden uncontrolled acceleration to speeds of up to 100 miles per hour or more," as well as "defective electronics and the absence of a fail-safe, such as a brake-to-idle override system.

For many Americans, few experiences with the healthcare system are more frustrating than a rejected claim from an insurance plan. Rejection notices are often unclear, as are the procedures for challenging them. On Thursday, the Obama administration issued new rules designed to simplify the process and expand consumers' rights, as required by the recently enacted healthcare law. Here are some questions and answers about how the new protections will work. Do Americans already have the right to appeal if a health plan denies coverage for something?

A Los Angeles-based law organization Wednesday launched a program to provide free legal assistance to veterans who hit bureaucratic roadblocks when filing claims for federal medical and mental health benefits. Public Counsel, a pro bono law firm, will offer the free service throughout Southern California and, in partnership with other volunteer attorneys, in more than 25 states. "Many veterans who return home to their families are facing a system that routinely rejects their benefit claims," Los Angeles Mayor Antonio Villaraigosa said at a Veterans Day news conference to announce the effort.

An Oklahoma couple driving home from church hit an animal -- a really big one. An elephant that had escaped from a circus collided with the couple's SUV Wednesday night when it ran across a rural highway in Enid, about 70 miles north of Oklahoma City. The couple weren't injured, but police say the elephant suffered a broken tusk and an injured leg. Authorities said the tusk tore a hole in the SUV's sheet metal.

Who should pay when a health insurer screws up? Not the insurer, apparently. Seal Beach resident Kelley Barton wanted to be sure that a treatment would be approved by Anthem Blue Cross when she sought medical care last year for her 14-year-old son, who had suffered from chronic constipation since he was a little boy. "I wouldn't even schedule the procedure until I knew it was covered," Barton, 51, told me. "I knew it probably wouldn't be...

Ephram Nehme was gravely ill when Anthem Blue Cross of California agreed to pay for a liver transplant his physician said he needed to survive. Then, his condition went downhill fast. The news from his doctor was bad. The word from his insurer was worse. Nehme's doctor told him he could die waiting for an organ in California and urged him to go to Indiana, where the waiting list was shorter. But Anthem Blue Cross said no. It would not pay for a transplant in Indiana. Nehme, a Lebanese immigrant with a rags-to-riches story, could afford to buy himself a new lease on life and did -- going to Indiana and paying $205,000 for a liver transplant there.