HMO FAQs: Are HMOs really all bad? Why are there so many HMO horror stories?

HMOs make more money by not providing care to patients. The medical group or doctor working with an HMO is paid a fixed amount each month, whether or not care is provided. Therefore the most profitable situation for the HMO is when no care is provide… Read More
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Why do HMOs have such a bad reputation?

In the pursuit of profit, HMOs have negotiated ever-declining rates with their providers. As a result, many medical groups and hospitals have gone bankrup… Read More
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FAQS: HMO Doctors and Specialists

h3>Do I have to see the HMO's doctor? It depends. HMOs are obligated by law to make medically necessary care available to their members within a reasonable time. So, if the HMO has a qualified doctor in the network, but the doctor is so busy… Read More
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What is ERISA? Can I sue my HMO for punitive damages?

ERISA preempts (that is, overrides) many state laws that regulate employee benefit plans. Simply put, if you obtain your health insurance, life insurance, or disability insurance through a plan set up by your employer, ERISA probably applies. If it d… Read More
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How ERISA Law affects the insured's rights

If the insurance at issue in a potential case was obtained through an employer, the claims of the insured person or their beneficiary against the insurance company are likely subject to a federal law called the Employee Retirement Security Act of 197… Read More
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The genuine-dispute doctrine after Wilson v. 21st Century Ins. Co.

The genuine-issue defense was first announced in Safeco Ins. Co. of America v. Guyton (9th Cir. 1982) 692 F.2d 551, an appeal from a judgment awarding declaratory relief to the insurer, finding that it owed no coverage for property… Read More
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The ever-expanding genuine-dispute doctrine, and how to deal with it

The genuine-dispute doctrine has become the legal equivalent of kudzu – an invasive species known for its explosive growth. This doctrine has become the first line of defense relied on by insurance companies who have been sued for insurance bad-fai… Read More
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The Trivial-Defect Doctrine: Where It Came From. How to Beat It.

The “trivial-defect doctrine” is the defense strategy of choice in sidewalk trip-and-fall lawsuits. It is a formidable weapon because it allows a judge to determine that the sidewalk defect that caused the plaintiff’s fall was “trivial” and… Read More
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Six Tips for Effective Writ Practice

A "writ" is an order issued by the reviewing court to an inferior tribunal, typically the superior court, directing it to do something (mandate) or forbidding it from doing something (prohibition). Article 6, section 10 of the California Constituti… Read More
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When Arbitration Becomes Impossible: When are parties excused from an agreement to arbitrate?

Arbitration deters claims because it is expensive. Someone who wants to file a civil lawsuit has to hire a lawyer and may have to pay the costs of depositions and experts. But the costs of having a forum to hear the case are usually nominal. In arbit… Read More
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