Insurer to Pay $10M for Rescission Based on HIV
By JEFF GORMAN
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(CourtHouse News) - An insurance company's "reprehensible"
decision to rescind a South Carolina man's coverage after he tested
positive for HIV warrants a $10 million punitive damage award, the state
Supreme Court ruled.
Jerome Mitchell applied for health insurance with Fortis Insurance
Co. in 2001 at the age of 17. Fortis issued him a policy after he stated
that he had never been treated for an immune deficiency.
One year later, Mitchell tried to donate blood to the Red Cross,
which informed Mitchell that he was HIV-positive. Mitchell's doctor
confirmed this finding.
Fortis investigated Mitchell's medical history and rescinded his
policy, stating that Mitchell had misrepresented his HIV-positive status.
Mitchell sued for breach of contract and bad faith and presented
evidence that he would die of AIDS within four years without medical
treatment.
The trial court ruled in Mitchell's favor, awarding him $186,000
in actual damages and $15 million in punitive damages.
The state high court upheld the awards, but reduced the punitive
damage award to $10 million based on the ratio of the projected $1
million cost of Mitchell's treatment.
"We find ample support in the record that Fortis' conduct was
reprehensible ... Fortis demonstrated an indifference to Mitchell's life
and a reckless disregard to his health and safety," Justice Toal wrote.
Before the cancellation of the policy, an underwriter working for
Fortis wrote to a committee considering whether or not to rescind his
policy: "Technically, we do not have the results of the HIV tests. This
is the only entry in the medical records regarding HIV status. Is it
sufficient?" The underwriter's concerns were ignored and the rescission
went forward.
- - -
An investigation this summer by the House Energy and Commerce Committee,
and earlier ones by state regulators in California, New York and
Connecticut, found that thousands of vulnerable and seriously ill
policyholders have had their coverage canceled by many of the nation's
largest insurance companies without any legal basis. The congressional
committee found that three insurance companies alone made at least $300
million over five years from rescission. One of those three companies
was Assurant.
In Febuary 2008, a private arbitration judge in Los Angeles ordered
Health Net Inc. to pay more than $9 million to a breast cancer patient
whose health insurance it revoked shortly after her diagnosis and while
she was undergoing chemotherapy. The plaintiff in that case, Patsy
Bates, a then-52-year-old grandmother and hair-salon owner, was unable
to continue her chemotherapy for several months.
During the case, evidence emerged that Health Net had paid bonuses to
employees to reward them based on the number of policyholders they had
rescinded. The judge who awarded Bates the $9 million said in his
decision: "It's difficult to imagine a policy more reprehensible than
tying bonuses to encourage the rescission of health insurance that keeps
the public well and alive."
Read more at:
http://www.huffingtonpost.com/2009/0..._n_289841.html
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