Insurance Claims

Anthem Blue Cross, the state's largest for-profit health insurer, has agreed to pay a $1-million fine and offer new coverage -- no questions asked -- to 2,330 people it dropped after they submitted bills for expensive medical care. As part of a deal that the California Department of Insurance is set to announce today, Anthem also will offer to reimburse those people for medical expenses that they paid out of pocket after they were dropped.

California regulators said Monday that insurers must provide speech, occupational and physical therapies to their autistic members but rejected pleas to require insurers to cover the cost of behavior therapy that aims to help patients live in society. At issue is so-called applied behavior analysis, a therapy that teaches patients skills such as self-feeding and stopping injurious behaviors such as head banging. The therapy can cost as much as $70,000 a year per patient.

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.

Michael Jackson was scheduled to undergo a second physical by an insurance company doctor at the time of his death, according to the terms of the policy purchased by the promoter of his planned comeback concerts in London.

U.S. property and casualty insurers are expected to pay $6.5 billion in losses from 23 catastrophes during 2007, much of it from California wildfires, according to ISO Inc., a company that supplies statistical information for the industry. That figure, however, is dwarfed by those of earlier years when multiple major hurricanes slammed into the U.S. When Hurricane Katrina devastated New Orleans in 2005, property insurers paid more than $62 billion.

Lawmakers and regulators took aim at California health insurers Tuesday in efforts aimed at making sure they cover members' medical needs and pay physicians and hospitals what they owe them -- and on time. A day after the state Senate killed Gov. Arnold Schwarzenegger's plan to expand healthcare coverage, Insurance Commissioner Steve Poizner vowed to make sure that current insurance laws were strictly enforced and ordered new audits of the state's largest health insurers.

As a customer-service manager at China Pacific Property Insurance Co., Shen Jie paid visits to dozens of policyholders whose homes and cars were destroyed or damaged by the May 12 earthquake. After recording each case, he could only shake his head. "It's a shame that we can't compensate any of these car and house claims," said Shen, 38, who works at the firm's Mianyang branch in Sichuan province.

Insurers' losses from natural disasters rose about 50% in 2008, with Caribbean hurricanes Ike and Gustav powering the increase and climate change increasingly a factor, a leading reinsurer said Monday. Munich Re said in an annual review that insured losses came in at $45 billion this year, up from nearly $30 billion in 2007. It said total economic losses, including losses not covered by insurance, leaped to about $200 billion from last year's $82 billion.

State Farm Fire & Casualty Co. will reexamine more than 35,000 policyholder claims filed after Hurricane Katrina and "make millions of dollars available" for additional payments, Mississippi Insurance Commissioner George Dale said Monday. Dale said the agreement between his office and State Farm covered homeowners, renters and commercial claims in the state's three coastal counties. The agreement with the Bloomington, Ill.

Under landmark legal settlements reached in 2004 and 2005 between state regulators and UnumProvident Corp., one of the country's largest disability insurers, the company was required to reopen hundreds of thousands of disability insurance claims that it had rejected. But as Unum prepares to close the books on the claims-reopening process this year, the company says it will have reviewed fewer than 10% of the 290,000 claims eligible for a second chance, including 25,000 in California.