Laurel to Denver’s Westword

For explaining how insurance companies behave

It was a riveting tale that reporter Alan Prendergast told in Westword, the Denver alternative weekly. Graphically and methodically, he showed how a Wisconsin-based insurance company by the name of Assurant Health fought one of its policyholders in court, trying to prove that she had been untruthful on her application for coverage. The Assurant case is significant, since the company is one of the biggest sellers of policies in the individual insurance market and stands to win big time under health reform. It is also one of the largest sellers of temporary insurance—so-called gap policies sold to people between jobs.

Prendergast’s story showed just how temporary its coverage can be. He chronicled the ordeal of Jennifer Latham of Longmont, Colorado, which began when she was seriously injured in an auto accident nearly five years ago. A parolee with a drug record rammed her car, leaving her with head trauma, internal injuries, and heaps of medical bills that she thought Assurant Health would pay. Instead, the insurer notified her that, on her application, she hadn’t disclosed several things: that she had discussed with her doctor a uterine prolapse with surgical resolution; incontinence; an ER visit for shortness of breath; and some “abnormal” diagnostic tests. The company gave her fifteen days to return a consent form, removing herself from coverage. If she didn’t, the company would toss her kids off the policy, too—a practice now outlawed under the new legislation. Assurant had rescinded her policy just when she needed it the most.

Latham went on the offensive, and sued Assurant for breach of contract and bad faith. The case dragged on for four years. Assurant’s lawyers offered $1 million to settle; she refused, a gutsy move for someone supporting four kids on Social Security payments of less than $1,700. After a two-week trial where her attorney asked the jurors to send a message loud enough “so that Milwaukee can hear you,” Latham won $37 million in punitive and compensatory damages, one of the largest bad-faith judgments in Colorado history. With tears in her eyes, Latham said: “Maybe this will change the way they do business.” Maybe. Time will tell.

Prendergast did the kind of reporting that is a rarity these days. He reported on the trial’s twists and turns. He told his readers about the cross-examination of the company’s highest-ranking witness, a manager who oversees the rescission process. He reported that the jurors had nicknamed her Cruella, and that the company had done so many rescissions the week Latham lost her coverage—“109 in two hours, 68 seconds apiece”—that they had to schedule three cases, including Latham’s, for the next day.

Throughout the story, Pendergast revealed much about the inner workings of an insurance company. He provided a kind of an insurance 101. In a separate piece, he described how insurers in the individual market engage in the practice of “disciplined risk management” and make oodles of money doing it. It’s how they trim the risk pool of costly claims, like the ones resulting from Latham’s accident. He reported on the cases of other Assurant customers and described the process of post-claims underwriting—reviewing policyholders’ medical records after they’ve filed claims, and then rescinding the coverage. He looked at congressional testimony last summer, in which Assurant’s CEO Donald Hamm insisted that the company’s application forms “are written in simple, easy-to-understand, straightforward language.” Then, under questioning by Michigan’s Bart Stupak, Hamm admitted that he didn’t even know what some of the medical conditions were that his company was asking about on its applications.

The kind of story that Prendergast wrote is pretty rare these days. It moved away from the dreary horserace stories and minute-by-minute drama that were so much a part of the health coverage in the weeks leading up to the bill’s passage. With reporting capacity down across the nation’s media outlets, stories like these might become even rarer. But they will be needed more than ever if the press is to perform its watchdog function and monitor how the new law is working. While the MSM continues its obsession with politics and pony races, the alternative press shows it can expose the real story.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.