News

HMO FAQS: MHO vs PPO - How HMOs Operate and Make Money

December 3rd, 2014
The key difference between an HMO and an insurer is that HMOs provide the promised coverage to the member (either directly or indirectly) while traditional insurance simply pays for care that the policyholder has obtained, after the care was rendered… Read More
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How to Read an Insurance Policy

December 3rd, 2014
The law requires that insurance policies be drafted in clear language. But anyone who has tried to read an insurance policy knows that they are seldom clear and that they are almost always difficult to read and understand. Determining what the policy… Read More
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HMO FAQs: Are HMOs really all bad? Why are there so many HMO horror stories?

December 3rd, 2014
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?

December 3rd, 2014
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

December 3rd, 2014
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?

December 3rd, 2014
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

December 3rd, 2014
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.

December 3rd, 2013
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

August 31st, 2013
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.

January 31st, 2013
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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