AG Ferguson: Insurance company must repay every penny to Washingtonians it denied due to mental health discrimination (2024)

Lawsuit results in important reforms to the travel insurance industry to provide protections for individuals experiencing severe mental health events

OLYMPIA — Attorney General Bob Ferguson announced today that Allianz, the world’s largest insurance company, must pay $1.5 million for discriminating against 560 Washingtonians with mental or nervous health disorders.

Allianz sells travel insurance to millions of Washingtonians. It promises to reimburse customers for trip cancellations caused by a “covered illness” or “medical condition.” Allianz covered losses caused by physical health conditions like a broken leg or a heart attack, but denied claims made by Washingtonians whose trips were disrupted as a result of mental health events.

Allianz based the denials on a discriminatory “Mental and Nervous Health Disorder” exclusion contained in its policies. Allianz did not adequately disclose to Washingtonians that its policy discriminated against customers based on mental health. When Washingtonians purchased travel insurance from Allianz, they had no way of knowing Allianz’s policy discriminated against people with mental health disabilities without doing a deep dive on the company’s travel insurance website.

As a result of Ferguson’s civil rights lawsuit, Washingtonians harmed by Allianz’s discrimination will receive full reimbursem*nt for their travel losses and the premiums they paid — plus interest. This will total approximately $800,000.

The Washingtonians receiving restitution include:

  • A Spokane couple who purchased travel insurance for their cruise trip before the husband was diagnosed with dementia. After the diagnosis, his physician recommended the couple limit their travel. Allianz rejected their claim, despite having medical records showing the doctor’s advice.
  • An Olympia couple who purchased travel insurance for their tickets to California for their son’s wedding, but the wedding was canceled after their son had a mental health episode and attempted suicide. Allianz denied their claim.
  • A Seattle woman who traveled abroad as part of a graduate school project. She returned home five days into the six-week trip after experiencing multiple panic attacks. Allianz denied her claim, and she had to pay $1,200 to change her travel plans.

Allianz will also pay approximately $700,000 to cover the cost of distributing the financial restitution and the costs of the Attorney General’s Office investigation and litigation.

Moreover, Allianz will be subject to a binding court order preventing it from seeking approval from the Office of the Insurance Commissioner (OIC) to use the discriminatory exclusion for the duration of the consent decree.

The resolution comes in advance of a trial that was scheduled to begin on Wednesday, January 17.

“Allianz would accept a claim over a broken foot, but not a life-altering mental health diagnosis — that’s not fair, and it’s not lawful,” Ferguson said. “Mental health conditions are just as real and serious as physical conditions — and both have protection under the law.”

Attorney General Ferguson’s litigation covered denials of claims by Allianz from January 2014 to February 2023. If your travel insurance claim to Allianz was denied during that time because of a mental or nervous health disorder, we want to hear from you. Contact the Wing Luke Civil Rights Division by emailingtravelinsurance@atg.wa.gov.

Details of the investigation

Ferguson’s investigation into Allianz started in 2019, after the Attorney General’s Office received a complaint from a Washingtonian whose claim for a travel reimbursem*nt was denied as a result of the company’s practice of excluding coverage for those experiencing mental health conditions.

The Wing Luke Civil Rights Division found that, between January 2014 and February 15, 2023, Allianz denied 560 claims from Washingtonians whose travel was interrupted due to a mental health event.

Ferguson’s investigation found that Allianz’s policy of denying coverage for travel losses due to mental or nervous health disorders unfairly discriminated against people based on disability, which is a protected class under the Washington Law Against Discrimination. Their claims were denied when their condition prevented their travel, unlike claims that were paid for those whose physical ailments disrupted their plans.

It also violated the state Insurance Code and Consumer Protection Act. To exclude claims based on disability, an insurer must first demonstrate both a significant statistical difference in their risk or exposure to cover the claims, and that the exclusion is not unfair. And the exclusion must be adequately disclosed to consumers shopping for policies.

The Attorney General’s Office’s investigation discovered that Allianz did not perform any statistical analysis to show whether covering travel losses related to mental health disability would have increased policy costs or Allianz’s risk. In fact, Allianz attempted to statistically justify the exclusion only after Ferguson began his investigation. Allianz claimed that removing the exemption would increase its risk and increase the cost of all policies, despite the fact that the 560 denied claims represent a tiny fraction of the 5.1 million travel insurance policies it sold in Washington since 2014. Even worse, Allianz’s discovery responses revealed that it implemented the exclusion based on the stereotype that mental health conditions, unlike physical health conditions, are difficult to “verify.”

As a result of Ferguson’s lawsuit, in 2023, OIC ordered all travel insurers to remove discriminatory mental health exclusions from their policies. Only then did Allianz change its policy.

Stories of impacted Washingtonians

As a result of Allianz’s conduct, hundreds of Washingtonians paid for a product that they were prevented from using due to a discriminatory exclusion. The following are examples of the experiences of Washingtonians affected each year by Allianz’s business practices:

  • In March 2019, a Vancouver resident purchased a plane ticket for his 9-year-old son. He purchased travel insurance from Allianz. Allianz denied his claim even after his son was diagnosed with bipolar disorder and schizophrenia, disrupting the travel plans.
  • In April 2019, a Tacoma resident purchased a flight to Michigan on a college visit. She purchased an Allianz travel insurance policy. Two weeks before her trip, she began to experience severe anxiety and decided that she could not travel. She canceled her flight and submitted a claim to Allianz. To support her claim, she submitted a letter from her psychologist explaining that she was in treatment for post-traumatic stress disorder and the resulting symptoms caused the cancellation of her trip. Allianz denied her claim.
  • As described above, in 2019, a Seattle woman who traveled abroad as part of a graduate school project. She returned home five days into the six-week trip, after experiencing multiple panic attacks. “I was shocked to find out Allianz did not provide coverage as I thought the policy covered travel costs associated with medical emergencies and it never occurred to me that a panic attack would not be considered a medical emergency,” she wrote in her declaration. “Even though I had purchased travel insurance, I ended up having to pay thousands of dollars to change my travel plans. It took a real emotional toll on me at a time when I was already dealing with a mental health crisis.”

Assistant Attorneys General Neal Luna, Mitchell Riese, Raina Wagner and Marsha Chien, former Assistant Attorney General Ashley McDowell, Investigator Jennifer Treppa, and Paralegals Logan Young and Anna Alfonso handled the case for Washington.

Ferguson created theWing Luke Civil Rights Divisionin 2015 to protect the rights of all Washington residents by enforcing state and federal anti-discrimination laws. Ferguson named the division for Wing Luke, who served as an Assistant Attorney General for the State of Washington in the late 1950s and early 1960s. He went on to become the first person of color elected to the Seattle City Council and the first Asian American elected to public office in the Pacific Northwest.

-30-

Washington’s Attorney General serves the people and the state of Washington. As the state’s largest law firm, the Attorney General’s Office provides legal representation to every state agency, board, and commission in Washington. Additionally, the Office serves the people directly by enforcing consumer protection, civil rights, and environmental protection laws. The Office also prosecutes elder abuse, Medicaid fraud, and handles sexually violent predator cases in 38 of Washington’s 39 counties. Visitwww.atg.wa.gov to learn more.

Media Contact:

Brionna Aho, Communications Director, (360) 753-2727;Brionna.aho@atg.wa.gov

General contacts:Click here

AG Ferguson: Insurance company must repay every penny to Washingtonians it denied due to mental health discrimination (2024)

FAQs

Why do insurance companies deny mental health claims? ›

Insurance companies may deny claims for various reasons, such as questioning medical necessity, citing policy exclusions, or failing to comply with parity laws.

Does Allianz pay claims? ›

Quick claim processing

Once we have all the information required, we can process and pay a claim within 48 hours.

How to fight back when your health insurance won't cover treatment? ›

If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the company's decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they've denied your claim or ended your coverage.

What percentage of insurance appeals are successful? ›

When consumers challenge a healthcare service their insurer denied, they win about half the time, data from California insurance departments show. The Affordable Care Act allows all consumers to appeal any denied service to a third party, like a state insurance department.

How do I get my full refund from Allianz? ›

For the fastest service, you can cancel your plan by visiting our online plan management tool. For a full refund of your premium, you must cancel within 15 days of your plan purchase (depending on your state of residence) and must not have filed a claim or departed on your trip.

Do insurance companies payout? ›

In insurance terms, a 'payout' refers to the money that an insurance company pays to a policyholder or their beneficiaries when a valid claim is made.

How do insurance companies get money to pay claims? ›

Insurance companies make money primarily from premium income, but they also invest the accumulated premiums in financial instruments to generate investment income. They also earn revenue from sources such as fees for policy services and commissions from partnering with agents and brokers.

Why are mental health disability claims denied? ›

Sometimes noncompliance is due to the claimant's inability to afford the prescribed medication, but the SSA usually doesn't consider affordability but focuses instead on whether or not the claimant has adhered to the prescribed treatment plan. Some mental disability claims are rejected on the basis of duration.

Can you be denied health insurance because of depression? ›

Pre-existing mental and behavioral health conditions are covered, and spending limits aren't allowed. Marketplace plans can't deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.

Does mental illness disqualify you from life insurance? ›

A mental illness does not automatically disqualify a person from life insurance eligibility. Since every insurance company has their own underwriting guidelines, it can be helpful to speak with a financial professional to navigate the rules and find which coverage may be a good fit.

Which is a common reason why insurance claims are rejected? ›

The claim has missing or incorrect information.

Whether by accident or intentionally, medical billing and coding errors are common reasons that claims are rejected or denied. Information may be incorrect, incomplete or missing. You will need to check your billing statement and EOB very carefully.

Top Articles
Latest Posts
Article information

Author: Amb. Frankie Simonis

Last Updated:

Views: 5628

Rating: 4.6 / 5 (56 voted)

Reviews: 95% of readers found this page helpful

Author information

Name: Amb. Frankie Simonis

Birthday: 1998-02-19

Address: 64841 Delmar Isle, North Wiley, OR 74073

Phone: +17844167847676

Job: Forward IT Agent

Hobby: LARPing, Kitesurfing, Sewing, Digital arts, Sand art, Gardening, Dance

Introduction: My name is Amb. Frankie Simonis, I am a hilarious, enchanting, energetic, cooperative, innocent, cute, joyous person who loves writing and wants to share my knowledge and understanding with you.