By: Dennis R. Stout, Esq.
This maxim of law, caveat emptor, or let the buyer beware, generally stands for the principle that a purchaser of a product or service takes the risk of the quality or condition of the item being purchased unless there is some form of additional protection or warranty from the seller. Purchase of an item “as is” is at your risk.
Although this originally dates back to earlier times, with livestock, motor vehicles, and even real property, most recently this concept has evolved into the purchase by many families of “junk health insurance”. Individuals seeking reasonable health, major medical, or other comprehensive hospitalization coverage are being sold policies of insurance that are fraught with ambiguities and ripe for a denial of coverage and benefits.
Such is the case of an Inland Empire couple who recently litigated their case of fraud, breach of contract and breach of the covenant of good faith and fair dealing against the insurance company that sold them the “junk insurance” After believing they had purchased this comprehensive health coverage, (with a high deductible and a lifetime cap on expenses) upon presentation of a claim under the policy, the underlying insurance company denied or reduced what the individuals felt was a legitimate claim, under an ambiguous provision of the insurance policy. The insurance company paid approximately 25% of the accumulated medical bills leaving the couple with large outstanding “non-covered” medical expenses. Another victim of big insurance!
Although the end result at the trial stage was a victory for the insurance company, this practice of selling “junk insurance” is prevalent throughout the United States and likely will continue without careful evaluation of the language, terms, and conditions of the insurance policy itself. Also, who knows what effect this practice will have when the Affordable Health Care Act (ObamaCare) begins in 2014.
Review your purchase(s) carefully, whether it is a product, service, or your insurance policy. Attorneys at Heiting & Irwin have extensive training in claims related to all types of insurance policies, and are willing to assist at any stage of the process, up to and including litigating the claim. We offer free consultations in our warm, inviting office.
Don’t be a victim of buyer beware. Ask questions and obtain competent legal advice now.