The final day of November was anything but kind to many Oklahoma residents in in the east central part of the state. Residential occupants and business owners across a swath of counties were hit by multiple tornadoes, which reaped considerable property damage over a broad area.
Oklahomans got quickly to work in the storms’ wake, with an immediate focus being on identifying and treating personal injuries, assessing property damage and helping families and local municipalities secure assistance.
Many Oklahoma residents suffer from serious and/or chronic illnesses. For instance, it probably wouldn't be difficult these days to find someone who knows someone with cancer, diabetes or some other life-altering medical condition, or to find someone who suffers from one.
Researchers are doing what they can to find ways to cure these diseases, or at least prolong the lives of those who have them. Before treatments can reach the public, they must go through clinical trials involving those who suffer from these conditions. If you could participate in a study for a medication or other treatment that could improve your health and prognosis, you would probably want to do it, but would your insurance pay for it?
Here’s a dose of irony. Some sleep apnea sufferers commenting in an in-depth media piece centered on a breathing-assistance machine say that issues surrounding the device are worrisome enough to actually make them lose sleep.
The breathing tool is a continuous positive airway pressure machine, which understandably goes most often by the moniker of CPAP. The device helps users keep their airways open during sleep, enabling them to breathe better.
“You need to do something or you’re just going to keep getting sued.”
That was the pure-and-simple bottom line for an Oklahoma County jury that recently awarded damages in a bad-faith insurance case. One of the jurors stated in the wake of a trial concluded earlier this month that conduct engaged in by national health insurer Aetna evidenced “a broken system.” A message needed to be sent, and the jury unquestionably delivered one.
We delved into a judicial decision involving an insurance policy in a post from last month, noting that many people would find fault with it and question the heavy onus it seemingly places upon policyholders. Our October 26 entry stressed that, while insureds certainly must familiarize themselves with key policy points, they can hardly be expected to grasp fine-print subject matter equally as well as insurance industry experts.
Indeed, we stated that “it is close to impossible for most intelligent people to fully comprehend every aspect of an insurance policy.” Moreover, insurers bank on that reality; in fact, some bad-faith actors routinely rely upon it to exploit policy loopholes that lead to delayed or denied coverage.
This is a not a story of an insurance entity’s bad faith or questionable failure to act regarding a relatively limited number of policyholder complaints. Rather, it is a flat-out singular tale chronicling a huge issue confronting potentially 35,000 or more homeowners in one state.
That issue can be summed up by a single word: pyrrhotite. That tricky-looking word is the designation for an iron sulfide mineral. Pyrrhotite does not have any strongly noxious or adverse properties per se, but it is a beast when its characteristics are manifested in a home-building context.
“We have … determined that the treatment is medically necessary.”
Those were precisely the words that a woman recommended for entry into an in-house program for severe eating disorders was waiting to hear from her health insurance company. Following Wellmark’s approval of the precertification request, the policyholder formally entered a well-established treatment center to deal with her longstanding bulimia nervosa condition.
Many Oklahoma residents are struggling with legal situations having to do with life insurance. Perhaps you can relate to such situations from first-hand experience or because you have been helping your aging parent address long-term care needs. Life insurance companies often try to deny claims. The question you must answer if this happens to your family is whether the denial was for a valid reason.
Short of committing fraud, there are not many reasons that a life insurance company can deny your claim. The problem is that such situations are often complex and if you do not have a legal background regarding the issue, it can be quite difficult to understand whether what your insurance agency is doing is okay. That's why it helps to research the topic ahead of time and to have support access in mind should a problem arise.
We suspect that many readers of our insurance law blog across Oklahoma and elsewhere will find fault in the recent insurance-linked ruling issued by one state’s highest court. And we can understand why.
Namely, that tribunal is the Illinois Supreme Court, which ruled 5-2 in a decision released last week that a couple was time barred from bringing a claim against an American Family Mutual Insurance agent. The couple’s complaint was grounded in negligence and breach of contract centered on the agent’s failure to secure them the same level of coverage they had obtained in a previous policy. The agent was directly advised of the couple’s wishes prior to the issuance of their American Family policy.
The most relevant term concerning storm systems that move across Oklahoma is unquestionably “across.” Oklahoma is frequently a venue for nasty weather patterns that affect cities, towns and agricultural enclaves from one end of the state to the other. Widespread storms understandably pack a big punch, bringing the ready potential to inflict heavy damage relevant to both human life and property.
Oklahomans don’t have to think too hard to jog their memories for details of the most recent weather system that wreaked havoc across a wide swath of the state. In fact, it was just a couple weeks ago that problematic weather played out a large section of Oklahoma.
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