Freiberg and Peck, If I am sued, can my insurance company settle the case without my consent

Under most types of liability insurance, the insurance company has the contractual right to settle or defend the case as it sees fit. You normally will have an opportunity to provide input, but the company typically has no obligation to get your consent or approval. A common exception to this involves professional liability policies, such as medical malpractice or architects errors and omissions coverage, under which consent of the insured usually is required for any settlement.
What is a ‘reservation of rights’ letter
If you are sued, the legal complaint filed against you may state several different claims, some of which may be covered by your liability insurance policy and some of which may not be covered. The insurance company is obligated to provide a defense for you if any of the claims could be covered, but the company may not be obligated to pay the damages for certain types of claims. A "Reservation of Rights" letter from your insurer is a notice that even though the company is proceeding to handle your claim, depending on what happens, certain losses might not be covered by the terms of the policy. By such a letter, the company preserves or "reserves" its right to deny coverage at a later date based on the terms of the policy.

Liability policies, for instance, typically do not provide coverage for damages which you cause intentionally. If you injure someone under circumstances where the injury could have been accidental or could have been intentional, the legal complaint might allege both that your action was "negligent" and that your action was "intentional." In court, the party suing you will have to prove it was one or the other. In such a case, your insurance company may write a letter saying it will provide you a defense but it will not pay damages if the court finds you caused the injury intentionally. This is an example of a "Reservation of Rights" letter.

Freiberg and Peck, Advocates Hopeful That Lawmakers Will Approve Hospital Stay Coverage Mandates For Breast Cancer Patients

Congress has been "slow to act" on legislation (HR 758, S 459) that would require health insurers to cover hospital stays after a mastectomy, lumpectomy or lymph node dissection, but advocates "are hoping that with Democrats controlling Congress, the measure might finally be approved," the Chicago Tribune reports. The legislation would mandate that health plans cover hospital stays up to 48 hours after a mastectomy or lumpectomy and up to 24 hours after a lymph node dissection. The bill would not require a minimum stay time, but it would require insurers to inform policyholders of the benefit. According to the American College of Surgeons, the industry standard for hospital stays after a patient undergoes a mastectomy is a minimum of one night.

The House bill has 217 co-sponsors, and the Senate version has 18. Representatives from the office of Rep. Rosa DeLauro (D-Conn.), who introduced the House measure, said the lawmaker is "cautiously optimistic" about the bill's chances this year. Twenty states have laws that limit outpatient mastectomies. Where the state law is stricter than the proposed federal law, the state law would apply, according to legislation.

Christine Laronga, chief of the Comprehensive Breast Program at H. Lee Moffitt Cancer Center & Research Institute, said she would consider allowing a patient to have an outpatient mastectomy only if the person has had the procedure before. She added that most people who have a mastectomy stay one night, while a woman who has a mastectomy with reconstructive breast surgery stays at the hospital for two to five days on average.

Mohit Ghose of America's Health Insurance Plans said research has found that outpatient mastectomies are successful in treating breast cancer. "If we can get people out of hospitals quicker, that's going to be a better thing," Ghose said, adding that because some diseases can spread in hospitals, it could be better for people to recover at home (Wyckoff, Chicago Tribune, 3/9).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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