DAN "insurance"?

[AzAtty]

Genesis once bubbled...
Its not "resolved" unless DAN reimbursed their POLICYHOLDER for his legal fees, for any time he had to take to resolve the matter, and any damage sustained to his credit - which, if you believe him, was substantial.

Strawman argument. Read the first thread again. There is no evidence from the text that he had to pay legal fees or that he sustained damage to his credit. That was the second thread. There was only a delay in payment because, as DocVikingo indicated, the policyholder did not properly complete the paperwork. Why should DAN--or any other person--"resolve" the issue in the manner you suggest if the policyholder caused the problem by not completing a necessary document?

DAN has no claimed "policy limits", per-se, within that arena.

Every policy has limits. The reason is simply mathematical. You can't perform a meaningful actuarial calculation when one of the variables in your expected loss equation is infinity because the result is infinity. Thus, the policy premium to cover that loss would be infinite. I double dog dare you to find a "no limits" policy on this planet. If you do find one, please tell me about it because I want it. DAN's lifetime policy limits on its "standard" plan are $45,000.00. On its "preferred" policy the limits are $250,000.00 per occurrence. However, we're both speculating about what *could* have happened. Neither of us have adequate information to make any meaningful conclusions.

Genesis once bubbled...
Is it a good idea to buy insurance from an organization that intentionally shields themselves from "bad faith" actions in advance? What does that say about their intent?

Although I agree that dealing with an offshore company--particularly Caribbean--is more difficult, and it's a cast iron pain to get any corporate or financial information from them, there are legitimate business reasons for going offshore. Favorable tax treatment immediately comes to mind.

Now, what if the insurance company was based in Australia? Or France? Or Japan? Or the Isle of Man? Or the Cook Islands? If you think the Caribbean is difficult, try the Isle of Man or the Cook Islands. Those places are legal black holes. Shoot, there are good tax reasons to incorporate in the Netherlands if you're going to do international transactions.

Yes, they may get a "shield" because of the corporate laws in that country, but that's a red herring. Similar shields exist in the United States. I can shield you against liability for the vast majority of legal problems in the United States simply by some careful choices concerning business organizations and forms of ownership. Is that indicative of "bad faith?" No. Using the argument that anyone who seeks to limit liability from their actions does so to shield against "bad faith", every person who organizes a corporation or limited liability company would be deemed to be taking actions in bad faith. Yet we all do business with those companies every day even though the corporate shield provides them with limited liability.

Furthermore, you see corporate gerrymandering even in the United States. People are flocking to Nevada right now to form corporations because that state has some favorable corporate laws. Delaware is home to more corporations than people (hyperbole) because its laws provided corporations with greater limits on liability and generally favorable treatment. So it happens here in the U.S., too.

Keep in mind, too, that there is another world of insurance called "reinsurance." Insurance companies reinsure their policies. Is that "bad faith" because they're doing something to minimize their exposure? No. It's called smart business.

One cannot conclude that a company takes a particular action to shield against "bad faith" simply on the basis of its corporate domicile. Furthermore, a single, hearsay anecdote cannot provide credible proof of "bad faith" intent. Is there an issue with offshore companies? Yes. I'm not particularly fond of them, but I understand their legitimate uses and under the right circumstances I would suggest their use. Is the "bad faith" conclusion necessarily justified? No.

 

[Genesis]

Having talked with DAN, the current policies in the US are underwritten by US Life, a US firm - although coordinated offshore.

That takes care of the problem that I have with the "no recourse" issue..... so at least half of this is resolved.

The rest, DAN has promised to look into, and they have told me that there ARE issues with the "preferred provider network" (no different than other HMO or PPO problems that people have with various treatment protocols - so while this could be trouble in a particular situation, its not unique DAN.)

Apparently the problems with the chamber in the Keys with the "move stuff" is in the process of going away and is being actively worked on....

 

[AzAtty]

I agree that punitive damages provide a disincentive to take bad faith actions. However, to say that punitive damages are unlimited and available in every case may be overstating the point. The most recent Supreme Court case on the issue, State Farm Mut. Auto. Ins. Co. v. Campbell, 123 S.Ct. 1513 (2003) just came down last month. In that case, the Supreme Court determined that a punitive damages award of $145 million was exessive when the compensatory damages were only $1 million. The Court also stated that the 14th Amendment places constitutional limits on punitive damage awards.

The point here is that DAN appears to have avoided that "check and balance" by locating their insurance arm offshore...

I assume you mean the "check and balance" of punitive damages. I don't think one can make that statement unless s/he has a firm grasp on the laws of the domicile country. I can't tell you what limitations there are on damages in St. Kitts or Grand Cayman or wherever, so I can't evaluate whether that check and balance exists or does not exist.

 

[runvus4]

My read-through of the summary from the first link isn't quite the same as yours Genesis, and also from the response from DocVikingo who got directly involved.

1) Wife gets DCI hit and is rushed too compression chamber.
2) Husband doesn't have insurance info at time of admission and did not fill out the insurance parts of the forms
3) Upon return the next day, he submitted copies of all insurance (but doesn't say that he personally updated the appropriate forms with the previously missing information).
4) DAN and Treatment center states that everything will be taken care of
5) Turns out that the paperwork was not updated properly by whomever was given the copies of insurance information
6) DAN doesn't provide payment for it's share because paperwork is not in order
7) Medical center reports non-payment to credit agencies, medical center's attorneys contact husband
8) DocVikingo, husband, calls DAN, operator states that everything will be taken care of, but isn't due to paperwork still not being properly filled out
9) Husband, DAN and medical center get together and straighten out paperwork
10) DAN pays medical center
11) Medical center removes non-payment notice from credit agencies

I don't read that the husband ever engaged his own attourneys, and the reporting of non-payment/clearing of the credit report is I believe a fairly standard medical center collections practice. Most medical centers policies is that if they don't get paid by the insurer, that the patient is responsible for the outstanding fees directly.

The only real fault I can see is that the medical center and DAN personel whom told the husband that everything was going to be taken care of should not have said so without reviewing the paperwork, even after the fact and informing the husband of what part of the paperwork was out of order for him to take care of. That's a result of buracracy.

 

[DivePartner1]

The first few posts shows an interesting and uncritical rush to judgment.

Juries are composed of 'reasonable' folks like us? [shudder]

 

[Genesis]

The only real fault I can see is that the medical center and DAN personel whom told the husband that everything was going to be taken care of should not have said so without reviewing the paperwork, even after the fact and informing the husband of what part of the paperwork was out of order for him to take care of. That's a result of buracracy.

The simple fact of the matter is that DAN owes a duty to their insured, and if they tell someone that all is in order, that person should be able to rely on that.

They were obviously not, and further, they had to enlist third-party help to get it resolved AND had their credit banged (which doesn't happen instantaneously) as a consequence.

I do not excuse such actions. Again, this isn't a matter of being short-changed $20 or somesuch - it is a matter of a black mark that probably has NOT been actually "removed" from this individual's credit - rather, they now show "paid" but the fact is that the debt was never really theirs in the first place.

This kind of "damage" is often done but almost never really "un-done", and in this context it is simply inexcusable. It was not impossible for DAN to follow up on this and insure that it was taken care of, especially given that they told their insured that all was in order.

Once they did that, the responsibility is theirs, and the ball pretty clearly was dropped.

My initial point - whether or not the insured truly has been "made whole" - still stands.

 

[runvus4]

Aside from you being much much more emphatic, did it just take you 6 paragraphs (albeit small ones) to restate what I said in one?

Yes, DAN's phone droid should not have said that things were ok when they didn't review the paperwork. Neither should the medical center billing staff. They were both at fault.

As for the debt, it really was theirs in the first place. The forms at all medical centers I know of (and I don't know that many but I did some gopher work in the accounts receivable of a doctors office in high school) all state that any charges are the responsibility of the patient. Many also state that if they do not receive payment from the insurer, the patient has to remit payment and be later reimbursed by the insurer, or the medical center if the insurer pays the medical center.

As well, AFAIK, notices in the credit reports of a medical bill non-payment is not the same as a default on a line of credit. Once those are removed, they are truely removed, they don't linger about for 7 years.

Lastly the husband did not enlist a third party to help get it resolved. The only mention of attourneys was of the Medical Center's attorneys contacting him about non-payment.

In the end, what resolved the issue was to get the treatment center, DAN and the husband on the phone at the same time to straighten out paperwork.

If you want to assign blame, the husband already did a mea culpa for his part in that he did not properly fill out the paperwork initially, and when he brought in the missing information, did not personally correct or witness personally the paperwork revision, which was the root problem (kind of like a oxygen tox hit when you don't personaly analyze or witness analasys of your nitrox tanks).

The Medical center is at fault for not going back and filling out the paperwork properly once they received copies of the medical insurance information.

DAN is at fault for having some phone droid reassure the husband twice that everything was in order when it wasn't.

I'm not saying that anyone is clean or that this wasn't a significant concern/headache for the husband/wife, but I am saying that this one issue, where the Husband's not insuring that the billing forms were filled out properly in the beginnnig is not a sign of an endemic problem with DAN insurance. It is an example of buracracy gone wrong, where one missing field in a form can mess up your life.

 

[Genesis]

I'm not saying that anyone is clean or that this wasn't a significant concern/headache for the husband/wife, but I am saying that this one issue, where the Husband's not insuring that the billing forms were filled out properly in the beginnnig is not a sign of an endemic problem with DAN insurance. It is an example of buracracy gone wrong, where one missing field in a form can mess up your life.

Perhaps you accept that people who you contract with to do a thing and who assure you - twice - that all is ok can "make a mistake" and all is "ok" from your point of view, even after it costs you significant time, aggrevation, and perhaps even money.

I do not accept such "performance", and I will argue that it is precisely the attitude that its "no big deal" that is the reason we have such problems in the first place!

If more people held a firm's feet to the fire - HARD - when they did something like this, and hit them in the wallet a few thosand times, this kind of stupidity would go away - or those who cannot be bothered to have better than "phone droids" would go away.

 

[runvus4]

I don't accept personally from some phone droid general statements that that things are OK if it's a "big deal" issue like this was for the husband and wife. I'm pretty certain that you would not have either.

Personally I would have filled out the forms correctly in the first place. When I go diving, I have all my insurance cards in my wallet, a copy of my insurance cards in my logbook

I would have brought out my copy of the paperwork and gone over line by line to make sure everything was in order. Once that was done, it would have resolved the issue. If not, then I would have spoken to the shift supervisor on a followup call.

My issue was not ment to imply that there wasn't a royal mess, because there was. My comment is that this situation is not a sign of systemic problem at DAN with fufilling their insurance responsibilities.

 

[Genesis]

if you're the one it happens to.