INSURER CANNOT DIRECT MEDICAL CONTROL OR EXERCISE MEDICAL JUDGMENT

CALIFORNIA INSURANCE CODE SECTION 10133(b)

“Nothing in this section shall be construed to authorize an insurer to furnish or directly provide services of hospital…physicians, or in any manner to direct, participate, in or control the selection of the hospital, or health facility of physician,…from whom the insured secures services or exercise medical…professional judgment, … “



BAD FAITH BY INSURANCE COMPANIES

CALIFORNIA INSURANCE CODE SECTION 790.03. The following are hereby defined as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance.

[5] Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear;

[7] Attempting to settle a claim …for less the amount to which a reasonable person would have believe he…was entitled.

[12] Failing to settle claims promptly, where liability has become apparent…

[14] Directly advising a claimant not to obtain the services of an attorney.

For a full copy of this important Bad Faith Insurance Code contact johntawlian@shawnsteel.com

This year our seminars are concentrating how a practice may protect itself against a dishonest insurance adjusters. Look for these issues:

1. Sheep Clothing. Often adjusters will call your office to learn too much about your patient’s diagnosis and treatment plan. All sorts of privacy violations. Instruct your staff never to discuss your patient’s conditions.
2. Misleading. Sometimes they lie. See the Bad Faith law 1st column. Bad adjusters will advise your patient not to see you---but go to Kaiser instead. Or, that if the patient uses med pay their premiums will go up [no true---ask us for the law]. Solution --- tell the patient to stop talking and tell the adj to speak to his attorney.
3. Telling half-truths. That the patient is not really that hurt. Or that the patient is partially responsible
4. Scare tactics. That the doctor is in ‘trouble’ or the case is being ‘investigated’.
5. Behind your back. Allstate recently sent a letter to a patient advising her that chiropractic was inappropriate care!
6. Adjuster turnovers. Most adj’s don’t stay long. It’s not a pleasant job. Today’s adj’s get their instructions from Colossus. They merely impute what you send them. [Key point!]
7. Mood Swings. Carriers are bought and sold. Farmers just purchased 21st Century. No more nice 21st Century. AIG was seized by the feds — was the largest in the world before that. Progressive is not progressive.
Wednesday, March 23 @ 1:00 PM Sharp!

Adding Active Care -- The Next Wave
With Special Guest
Dr. David Cruz

E-mail johntawlian@shawnsteel.com for telephone # and pass code.
Circle the date
Saturday, April 30, 2011
More to come