Pre-Present Situations, Congress And Erisa | Ask The Lawyer

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Pre-Existing Conditions, Congress And Erisa | Ask The Attorney

The United States Supreme Court is about to face a constitutionality case passed by Congress during the Obama administration. There is a lot of talk in the news about pre-existing conditions and health insurance. As personal injury attorneys, insurance companies argue every day that injured individuals had a pre-existing condition that either contributed to their injury or caused it in full. If they're successful, they don't have to pay that much money.

Many times in the days leading up to the ACA (Affordable Care Act) we saw people who were injured at work lose that job. With the loss of this job came the loss of family health insurance. If these people or family members had pre-existing illnesses such as diabetes, cancer, heart disease or hepatitis or a large number of illnesses that a health insurance company did not want to insure, these people could not take out health insurance that covered these illnesses – existing conditions.

People who do not have health insurance find it very difficult to seek treatment for chronic illnesses. The only way an uninsured person can be treated is by paying out of pocket or going to the emergency room, and there are no long-term solutions either. It was literally heartbreaking to see a family where the mother couldn't get treatment for an illness because she couldn't get health insurance.

In 1974, Congress passed ERISA. Nobody likes Congress. Mark Twain said, “Let's say you're an idiot and a member of Congress. but I repeat myself ". ERISA protects insurance companies from being sued for failing to offer treatment that your doctor wants you to receive but doesn't want to pay for. If your health insurance is through your employer, you cannot sue them for monetary damages because you or a loved one did not receive the necessary treatment because the insurance company refused, unless you are a member of Congress because of Congress freed himself from ERISA.

Obviously, insurance companies don't want to insure that people they know already have an illness or are at risk of developing a chronic illness. The Affordable Care Act in its current form provides protection for individuals by imposing an open enrollment period during which those who lose their insurance have the opportunity to take out insurance even though they already have an illness. We may see this change in the next few months.

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