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Contents
This booklet is protected by copyright under United States law and by international copyright laws and treaty provisions. You may copy and distribute the work provided that you use the work for personal, noncommercial use; do not add the work to a collection or use it with any other text, photographs, artwork, etc; do not modify or alter the work in any way or delete or modify any copyright; and do not publish or post all or any part of the work on any Internet site or in or on any other media without obtaining the prior written consent of Ohio Legal Rights Service. Copyright © 2003 Ohio Legal Rights Service. All rights reserved. Limited Rights Under the LawsAs in hiring, firing and promotion, federal and state laws prohibit disability-based discrimination by employers when they provide company fringe benefits, such as health insurance coverage. However, the Americans with Disabilities Act Title I (Employment) may allow employers to deny health insurance based on disability, if the employer can justify denial by insurance statistics and "actual substantial increase" in costs. Insurance companies may also deny health insurance. Under some circumstances the ADA Title III (Public Accommodations) does not regulate insurance companies when individuals apply to the companies for insurance directly. Although rights protections for people with disabilities are limited, you do have rights if you are refused an insurance policy, or if you are denied a particular claim under an existing policy. These rights are explained in your copy of the insurance policy. Time is usually very limited in insurance disputes. If you believe you have been wrongly refused a policy or denied a particular claim under your policy, Ohio Legal Rights Service strongly recommends that you respond as soon as possible. Internal (Provider) ComplaintsMost insurance complaints must first be presented to, and decided by, a neutral office of the insurance provider itself. Insurance policies define the internal complaint procedures and strict deadlines to file complaints. Time may be very short. If you miss a deadline, you may lose your right to file any complaint. External (Agency) ComplaintsThe insurance industry is regulated by several federal and state agencies, which generally receive complaints only after the insurance provider's internal complaint procedure is finished. These federal and state agencies represent neither you nor the insurance provider. For example, the stated mission of the Ohio Department of Insurance is "to be responsive to and safeguard consumer interests . . . while promoting a stable and competitive marketplace among insurance providers." The agency to receive your complaint depends upon the source of the policy:
Individual and Group PlansThe Ohio Department of Insurance (ODI) receives complaints about most individual policies and employers' group plans. Some complaints may be filed on-line. Ohio Legal Rights Service recommends that you contact ODI as soon as possible to learn about your rights given your particular policy and your particular complaint. Ohio Department of Insurance Employer's Self-Insured PlansThe U.S. Department of Labor (DOL) receives complaints about these plans under ERISA (Employee Retirement Income Security Act). Contact DOL's ERISA enforcement division as soon as possible to learn about your rights. U.S. Department of Labor You also have the right to file a lawsuit under ERISA after complaint procedures are finished. Consult a lawyer in private practice as soon as possible. For More Information and ReferralsFor a detailed reference, refer to A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2003 Update. This publication is available in print and on-line from the Kaiser Family Foundation. Kaiser Family Foundation For lawyer referrals, contact: Ohio State Bar Association (OSBA) Ohio Legal Services Funding for this PamphletOhio Legal Rights Service is authorized and funded to provide services by, and produced this pamphlet with funds through, the following State and federal laws:
Ohio Legal Rights Service does not discriminate in provision of service or employment because of race, color, religion, sex, sexual orientation, national origin, military service, disability, or age. Ohio Legal Rights Service Telephone 614-466-7264 Related Topics:
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