Practice Areas
Health Insurance Fraud
Certain unscrupulous companies are willing to take advantage of people by selling health insurance as major medical or comprehensive coverage when, in fact, the policies offer very little coverage at all.
Companies are required to accurately and honestly represent the products that they sell. When a company's misrepresentations cause harm, the company can be held responsible for the damage it causes.
Examples of Health Insurance Fraud Cases
Dana and Doug Christensen, Playa Del Rey, California
Dana and Doug Christensen purchased a health insurance policy from the Mega Life and Health Insurance Company in January 2001. Doug, who was 47 years old, was a bone cancer survivor. The couple specifically questioned their Mega insurance agent regarding whether the policy would protect Doug if his cancer recurred. The Mega agent assured them it would.
When Doug’s cancer did recur, though, the couple learned that most of their hospital expenses were not covered. The couple was left with over $450,000 in uncovered expenses before Doug passed away. In Doug’s last months he begged his wife to divorce him so she would not be stuck with his medical bills, but Dana steadfastly refused.
After Doug’s funeral, Dana was left alone with nearly a half million dollars in unpaid medical bills. The only person who could help her in this situation was a lawyer.
Dana contacted Antony Stuart and asked him to represent her. To the vast majority of attorneys, Dana’s case would have appeared to be about insurance bad faith, but Mr. Stuart was careful. He recognized that the real issue was fraud.
The Stuart Law Firm fought aggressively for Dana’s rights against Mega and its allies, who employed corporate defense attorneys from four other firms, and who resisted at every turn. For Dana Christensen, Stuart Law Firm obtained a public settlement with Mega and its co-defendants in the amount of $1.71 million.
April Capil of Pleasant Hill, California
During the meeting at April’s home in the Spring of 2008, the NASE agent followed the training provided to him by his Divisional Sales Manager, Shirley Umamoto. He first described the NASE as a national non-profit association dedicated to lobby the U.S. Congress for the interests of self-employed people and to provide benefits for them with the power of its “strength in numbers.” He presented a thick catalogue of benefits provided by the association. Although not outlined in the catalogue, one of those benefits, he said, was access to affordable health insurance.
April told the agent that she had a good health insurance plan in effect, but she needed one that would work for her both in California and Hawaii. Her greatest concern was that the coverage would be comprehensive for breast cancer treatment in both states. The agent didn’t tell her that her Blue Cross plan would be fine for this purpose. Instead he touted the plans offered through the NASE as though they would provide coverage that her current plan couldn’t match. The NASE plan he was recommending would cost her $100 more per month than her Blue Cross plan, but the agent convinced April that it was a better plan. As he skimmed through the pages of a pamphlet for something called the “Premiere PPO Plan”of the Mega Life and Health Insurance Company, he told April stories about health scares his wife had that were fully covered by the plan. He told her that she would never have to pay more than her deductible and co-insurance, even if she was diagnosed with cancer. Another advantage to the Mega plan he described was that its deductibles were “per-disease.” In other words, according to the agent, if April had an illness more than once, she wouldn’t have to pay a new deductible again. This struck April as far superior to her Blue Cross plan which required that she satisfy a deductible in each year of the policy, even for treatment of the same disease.
April was diagnosed with breast cancer in November of 2008 after she had moved to Hawaii and switched to the Mega plan. In the midst of April’s chemotherapy she developed serious gall bladder problems that required two surgeries, then a bronchial infection, then shingles, and later an abscess which also required surgery. The Mega Premiere PPO Plan covered very little of April’s life-saving treatment because the agent’s representations were false. There was no “per-disease” deductible, the plan’s benefits were very limited, especially the provisions for cancer treatment, and April was required to bear most of the cost of her medical care. The unusual limitations on coverage in the Plan that were never explained have left April with over $230,000 in uncovered medical expenses. Now healthy again, April has retained Stuart Law Firm to bring legal action against HealthMarkets, the NASE, and the Umamoto Division for fraud.
Darlene and Dave Henderson, Penn Valley, California
In April 2000, Darlene and Dave Henderson met with a salesman for the National Association for the Self-Employed who showed them the MEGA plan, which appeared to them to be a group PPO similar to others they had seen. David Henderson required surgery for a life-threatening aneurysm and a subsequent colostomy at a total cost of over $190,000. They learned the policy was not a group policy, and that its maximum benefits were very low in relation to typical medical expenses. MEGA paid just 14% of Dave’s medical expenses. Dave complained to the salesman, who said not to tell anyone. “I could lose my license,” the salesman said. The Hendersons’ case against MEGA and the National Association for the Self-Employed is scheduled for trial in Nevada Superior Court in May 2006. They are represented by Stuart Law Firm.
Linda and Jerry Hopkins, Hawthorne, California
After Jerry and Linda Hopkins purchased their MEGA policy in October 2004, Linda was diagnosed with stage-three ovarian cancer. She underwent surgery at a local medical center, where her bills totaled $250,000. Of this amount, MEGA agreed to cover $20,000. At the medical center, Jerry Hopkins was told there were four others in the cancer ward with the same insurance—and the same problem. Later, when Linda’s cancer returned, the medical center told Jerry it would be unable to provide the treatment she needed because her coverage was so poor. The Hopkins have retained Stuart Law Firm and are asserting a claim for fraud against Mega and the NASE.
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Product Liability
In America, we hold companies responsible for the safety of the products they design and manufacture. This keeps the public safe and provides recourse to individuals who suffer injuries as a result of unsafe products.
Americans can recover under the law when a particular brand of tire blows out on the freeway at foreseeable speeds, when a certain toy chokes infants, when a tobacco or asbestos company lies about knowing the dangers associated with its products, or when medical equipment fails to work according to a seller’s specifications.
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Defective automobile products
Drivers and passengers need to be confident that air bags and seat belts will work when they are needed. To protect the commuting and traveling public, automobile manufacturers must meet the safety standards for collisions, rollovers, and fires. Those who fail to do so may be held accountable under the law to the people who are injured as a result.
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Defective child products
The current tort system in the United States rigorously protects children against unsafe toys, bedding, and car seats. Although there are “tort reform” efforts under way that would remove such protections, today the maker and seller of an unsafe child product can be held responsible in a court of law for any injuries that the product causes.
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Defective medical devices
Companies that make and sell pacemakers, catheters, heart or brain stents, and dialysis filters must meet safety standards in order to protect the lives of patients. If it were not possible to hold companies accountable for meeting these standards, a patient who required dialysis would risk acquiring the HIV virus, or another dangerous virus, every time she required treatment. Heart patients whose pacemakers failed unnecessarily would not be able to do anything about it. Fortunately, our tort system permits citizens to hold companies that do not meet such standards accountable before a jury of our peers.
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Unsafe drugs
Inadequately tested drugs, or drugs whose safety tests raise red flags that their makers ignore, can kill or severely injure the people who take them. We should be able to have confidence in the drugs our doctors prescribe.
Consumer lawyers, tort laws, and the courts keep your medicine safe by providing you with the ability to hold a drug company accountable if it markets a drug without adequate testing or ignores test results in the rush to market.
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Professional Malpractice
Corporate executives who take advantage of society, like those at Enron or WorldCom, must know they are not above the law. We must be able to be have confidence in our lawyers, accountants, doctors, and dentists.
Business owners and professionals are responsible for the caliber of their work. If you suffer as a result of their errors, omissions, or negligence, they can be legally liable to you. You may recover through the legal system if you are damaged by fraud, non-performance, loss of data, or system or product failure.
Stuart Law Firm has decades of experience in this area and enjoys a reputation for successfully litigating complex professional liability cases against corporate directors and officers, lawyers, accountants, mortgage brokers, bankers, dentists, doctors, hospitals and their staffs, optometrists, therapists, mental health workers, appraisers, and real estate professionals.
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Insurance Bad Faith
It adds insult to injury when, after suffering the loss of a loved one or a home, your insurance company gives you the runaround, refuses to pay legitimate claims under the terms of your life insurance or homeowner’s policy, and acts inappropriately during the claims process.
If an insurance company subjects you to such abusive treatment, you can use the legal system to protect your rights under the laws and under your contract with the company through a cause of action for insurance bad faith.
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Invasion of Privacy
In this age of reality television, “peekaboo” warrants allowing for property searches without informing owners, and electronic communications that can be intercepted and monitored by governments, companies, or criminal organizations, your privacy is under greater threat with every passing day.
Contrary to what many believe, however, your privacy rights are not dead. When an American citizen’s privacy rights are violated, that citizen can hold wrongdoers accountable for the violation in a court of law.
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Wrongful Death
A child who loses a working parent through another’s wrongdoing should not have to experience a dramatic decrease in her standard of living. Our tort system provides survivors with the right to recover in court when another’s bad conduct causes the loss of a family member.
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Libel and Slander
Your reputation is important. A newspaper cannot knowingly and maliciously publish a false story about someone who is simply going about his daily business. An employer cannot post lies on the company bulletin board in order to set an employee up for a firing.
When another person threatens your reputation with false statements, you may vindicate your reputation and recover for the damage this causes in a court of law.
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Negligence
In our society, we owe one another a duty of care. Sometimes, though, people behave in an unreasonable way — even when they know better. If such unreasonable conduct causes you harm, you can recover for the damage you suffer as a result of that behavior in a court of law.
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Employment Discrimination
If you are performing on the job and contributing value to your company, no one has a right to deprive you of the fruits of your great work just because you are a woman, or come from another country, or go to a particular church. When an employer discharges or refuses to promote an employee on grounds such as these, the employee has a right to recover in a court of law.
Employees who take a stand in court against employers who discriminate do not only recover for their own injuries. They benefit society at large by deterring such employers from continuing to discriminate in the future.
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Sexual Harassment
You have a right to freedom from sexual harassment at work. You have a right to advance in your career without requests for sexual favors.
Unwanted sexual attention can create an intimidating, hostile, or offensive work environment. Verbal and physical conduct of a sexual nature can place your job, pay, or career at risk. The law does not require you to stand for such treatment. If you experience sexual harassment as you attempt to go about your work, you can hold those responsible for their misconduct in a court of law.
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Premises Liability
The law holds property owners responsible to ensure that their premises are reasonably safe. An owner who knows about an unreasonably dangerous condition on her property, but does nothing about it, can be legally liable if another person is hurt as a result.
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