The insurance industry is the 600 pound gorilla of lobbying, throwing its weight around Salem and Washington DC in a constant drive for greater profits. In Oregon, the insurance industry is, for all intents and purposes, completely unregulated -- the Insurance Commission is less of a regulator than a handmaiden to the industry, allowing it to claim to be regulated while in actuality doing nothing to help Oregonians deal with uncaring insurance companies.
The solution is to bring insurance under the Oregon Unlawful Trade Practices Act, just like EVERY other business in Oregon. Call your representatives in Salem and tell them that the insurance industry shouldn't have a unique "get out of jail free" immunity that lets them mistreat people and profit from their misery.
The beating of Stow drew national attention to sports hooliganism. It’s also brought to light a virtually unknown aspect of the legal system that cuts compensation to victims. In effect, Stow was sucker-punched twice: first by his assailant and then by his health insurer.
Although a Los Angeles Superior Court jury awarded Stow $18 million from the Dodgers and his assailants last year, he has yet to receive any money. And, in a bizarre twist, the Dodgers’ liability insurer, ACE Property and Casualty Insurance Company, stands to net $1.6 million from a side deal in the case.
“It is extremely frustrating for people who are sick, or dying, or who have loved ones who have died and are desperately in need of money.”
It’s all because Stow’s health insurer is entitled to a huge slice of the settlement, even before Stow is paid. A growing body of federal law, including a recent U.S. Supreme Court case, gives insurers power to recoup medical costs caused by a third party—in the face of state laws that specifically prohibit it. “This is what people pay premiums for,” says Stow’s ex-wife, Jacqueline Kain. “To worry about some insurance company taking what is his is absurd.”
The concept is known as subrogation. The modern version dates back to the American Revolution and was applied in areas such as property insurance. An insurer, for instance, might seek to be repaid by the maker of a faulty furnace that caused a fire in a building the company covered. In recent years, subrogation has mushroomed into a multibillion-dollar source of offsetting costs for private health insurers as well as Medicare and Medicaid. Medicare reaped nearly $2.5 billion last year, aided by a 2007 law that requires the federal insurer for the elderly to be notified of any legal settlements paid to its beneficiaries so it can subrogate the funds.
Such medical liens have reduced and delayed compensation in several cases—from the thousands of patients who suffered heart attacks or strokes from diabetes drug Avandia to the 1,000 Montana residents sickened by asbestos from a mine. “It is extremely frustrating for people who are sick, or dying, or who have loved ones who have died and are desperately in need of money,” says Allan McGarvey, an attorney representing some of the asbestos victims.
The liens have spawned companies and law firms that identify cases and, representing the interests of medical insurers, pursue patients who have received court settlements. A unit of Xerox recovered more than $1 billion for health-care clients in a recent three year period. Optum, a company owned by insurance giant UnitedHealth Group, is a major player.
Insurers and employers say getting back money in these cases helps lower premiums for all members of a group plan. University of South Dakota law professor Roger Baron disagrees. He says research shows the recovered money does little to reduce insurance rates while increasing executive pay and shareholder payouts. “It would be wrong to think that the insureds benefit from subrogated recoveries, because they don’t,” says Baron, who has consulted for injured people facing health-care liens.