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March 17, 2010

Insurance Company Allegedly Targeted HIV-Positive People and Dropped Coverage

Last September, the South Carolina Supreme Court upheld a verdict against the Fortis Insurance company for revoking South Carolinian Jerome Mitchell health coverage after he tested HIV positive. The case, Reuters reports, has helped expose a Fortis—now Assurant Health—policy of targeting policyholders living with HIV and dropping their coverage.

According to the article, previously undisclosed records from Mitchell’s case reveal that a computer program and algorithm tagged policyholders recently diagnosed with HIV for an automatic fraud investigation, and the company allegedly dropped coverage once it discovered any pretext to revoke the policies.

While insurance providers have often investigated policyholders shortly after they’ve been diagnosed with life-threatening illnesses, government regulators and investigators say singling out HIV-positive people is unprecedented.

An unnamed federal investigator told Reuters that the reason behind singling out HIV-positive people is relatively high cost of care.

“We are talking a lifetime of therapy, a lifetime of care…a lot of bills. Nowadays someone with HIV can live a normal life for decades. This was about money.”

In Mitchell’s case, the company dropped coverage because a nurse wrote down the wrong year of his HIV test. While Mitchell tested positive in 2002, the nurse erroneously wrote his diagnosis year as 2001—at one day before his application for insurance. After Fortis revoked his policy, Mitchell hired an attorney to help correct the problem and have his policy reinstated. The company reportedly ignored the attorney’s letters, prompting Mitchell to sue the company for $15 million. Last fall, the South Carolina Supreme Court ruled that Assurant Health must pay Mitchell $10 million in damages.

While the company has said it does not comment on individual customer claims, it issued a statement on Mitchell’s case:

“We disagree with certain of the court’s characterizations of Assurant Health’s policies and procedures in the Mitchell case,” Assurant Health said in a statement. “The case continues to progress through the appellate process.”

Search: Fortis, Assurant Health, insurance, South Carolina, Jerome Mitchell, policyholders, HIV, coverage

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