Rep. Cummings Calls for Investigation Into Whether Insurers Denied Claims to Civilian Workers Injured in Iraq, AfghanistanHouse Oversight and Government Reform Committee member Elijah Cummings (D-Md.) on Tuesday in a letter to Domestic Policy Subcommittee Chair Dennis Kucinich (D-Ohio) called for an investigation into whether American International Group and other insurance providers have routinely denied medical claims of civilian contractors injured in Iraq and Afghanistan, the Los Angeles Times reports. In the letter, Cummings cited a recent report that found that insurers have been denying claims and delaying payment for costly medical treatment of injured contractors (Miller, Los Angeles Times, 4/22). In addition, the investigation found that insurers protested about half of claims in which an injury resulted in more than four days of lost work, which accounts for about 9,000 of 31,000 total war zone claims. The insurers also protested more than half of post-traumatic stress disorder claims and more than one-third of cases in which a civilian worker was killed.
The high denial rates partly resulted from government rules that allow insurers only 14 days to judge the validity of a claim. According to the Times-ProPublica, insurers often reject claims initially and then later investigate the claims. The majority of the investigations are usually resolved through mediation, which takes between six to seven months on average, according to the Times-ProPublica. Cases that are unresolved through mediation go to court, where workers win about 75% of the time. However, the injured worker must pay for care out-of-pocket or delay treatment while the case is being contested. Such cases take an average of two years before a final judgment, according to an analysis of court files (Kaiser Daily Health Policy Report, 4/17).
Cummings said, "There are clearly serious deficiencies in the health coverage of civilian employees who have been injured while working overseas to keep us safe here at home -- costing not only the men and women who are being refused coverage for the treatment they need, but also for the American taxpayers who are footing the bill for their coverage."
AIG on Tuesday said it paid the "vast majority" of claims without dispute. Officials at DOL said that despite their limited resources, they had done their best to oversee the system (Los Angeles Times, 4/22). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.