After natural disasters like fires, tree falls, or burst pipes, we are attorneys who defend homeowners who have been underpaid by their property insurers. In order to hold insurers responsible, our cases go to jury trial if they don’t settle. Since Oregon law requires insurers to pay policyholders’ legal fees in the event of a recovery of any size, attorneys frequently embark on such matters on a contingency fee basis.
Much controversy has surrounded Luigi Mangione, whose manifesto attacks health insurance for their unjust rejections of coverage. However, the debate leaves out a crucial point.
The issue is that you cannot file a lawsuit against these insurers in a state court. Since the majority of Americans obtain health insurance through their employment, the federal ERISA statute applies to their health insurance plans. Health insurers are immune from state court lawsuits under ERISA. Additionally, consumers must use up all administrative remedies from the same health insurer that rejected their claims before bringing a lawsuit against an ERISA health insurer in federal court. This procedure is an intricate web of obscure regulations designed to eliminate the insured party’s ability to file a lawsuit.
Even if customers pass that test, a federal judge will resolve their claims rather than a jury. The court’s sole responsibility is to consider whether the insurer’s refusal was reasonable given the extremely low bar. The consumer’s claims will be rejected if the insurer’s decision has any justification.
The solution is to repeal ERISA and give consumers the ability to sue health insurers in front of juries. In order to subdue uncooperative health insurers, consumer lawyers will act as a legion of private attorneys general.
Portland’s Robert E.L. Bonaparte
Portland’s Stephen D. Leggatt
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