July 22, 2018

A Needed Response to 9News’ Misguided Story on Long-Term Care Insurance

Happy Summer everyone! This blog post features a rebuttal from the LTC Forum of Colorado, Inc., in response to a news story on 9News KUSA claiming that long-term care insurance is no longer a valid option for the middle class. The fact is that traditional LTC insurance is best-suited for the middle class!

The 9News story also ignores some of the newest solutions on the market, including life insurance that allows the death benefit to be used for care and hybrid life or annuity policies. Watch for more information on these solutions in my next blog or visit www.AaronEisenach.com for videos explaining these solutions. I can be reached at (303) 659-0755.

On June 12, 2018, 9News KUSA aired a story, “The Death of Long Term Care for the Middle Income Earners,” full of dangerous advice that may lead Coloradoans to costly conclusions based on myths and misunderstandings. The LTC Forum of Colorado, Inc., a non-profit advocacy group that supports and encourages long-term care planning in Colorado, is responding to claims in the story and wishes to set the record straight.

Claim:  Middle income earners (those who earn $87,500 per year) have been priced out of the long-term care market. Average premiums are $6,000 per year, which may be the low end.

Fact:  The annual premium for coverage from the best-selling company in the United States for a 60-year old single female is $3,273.17 per year.  A single male would pay $2,005.51 per year. Assumptions include a $5,000 monthly benefit, a 3-year benefit period, a $180,000 maximum benefit, a 90-day elimination period (similar to a deductible), preferred health rates, and a 3% compound annual inflation protection rider. Note that the inflation rider causes the monthly benefit and the $180,000 maximum benefit to grow each year by 3% of the previous years’ amount. The result is that by age 84, the monthly benefit will provide approximately $10,000 per month for care at home, in an assisted living facility or a nursing home, and the maximum benefit is worth approximately $360,000.

Claim: Premiums could go as high as $9,000 per year because insurance companies are telling current owners they could face a 50% hike at any point just because no one knows where healthcare is going.

Fact: Premiums cannot simply go up at any point. The Commissioner of the Colorado Division of Insurance has the responsibility of approving, denying, or modifying requested increases. Premiums cannot increase due to any one individual’s age, change in health, or due to use of the policy. Premiums can change if the insurance company makes the same change for all person of the same class.

True, long-term care insurance companies have increased premiums on policies sold in the past, mainly due to increasing longevity, low policy lapse rates, and historically low interest rates. To put this into perspective, let’s assume someone purchased a policy 15 years ago, in 2003, for $150 per month and that the premium has doubled to $300 per month. This is still affordable for folks making $87,500 per year. And this is a far cry from the claim that policies are increasing to $9,000 per year, which is equivalent to $750 per month.

In addition, companies offering LTC insurance policies today are including assumptions for low interest rates, very low policy lapse rates, and longevity. And because Colorado is one of more than 40 states that have adopted the National Association of Insurance Commissioners’ LTC Insurance Rate Stability Regulation, Coloradoans have much more regulatory protection from the type of rate increases we have seen in the past.

CLAIM: No one knows where healthcare is going.

FACT: Surely everyone believes that healthcare costs will continue to escalate. However, long-term care costs do not increase nearly at the same rate as health insurance and medical expenses. LTC costs are largely driven by personnel costs and the cost of building brick and mortar facilities. The good news is that more people will stay at home for extended care, often at lower cost than being in a facility, by taking advantage of a growing number of home care agencies and advancing technologies such as robots and sensors.

Claim: Benefits no longer cover all daily expenses.

Fact: People purchasing LTC insurance today can purchase policies with benefits up to $500 per day or $15,000 per month.  Because policies cost more today than in the past, it is now commonplace for consumers to design coverage to cover some, but not all, of the cost of care. For example, if an insured is receiving memory care in an assisted living facility at $7,000 per month, a policy with a $5,000 monthly benefit would cover more than 70% of the cost of care, leaving the policyowner $2,000 out-of-pocket, which is obviously better than $7,000 out-of-pocket. What’s more, a $5,000 monthly benefit would also cover more than five hours of home care every day for a month.

Claim: Many policyholders, because of financial decline or cognitive issues in their later years, let the policies lapse and then they lose everything – the future benefits they were paying for and then all the money they have put in over the years.

Fact: Regarding financial decline: First, only about 1% of LTC insurance policyholders let their policies lapse. This fact is one of the primary reasons premiums have increased.  Fortunately, if an insurance company files and receives approval from Colorado Division of Insurance for a premium increase, policyowners are able to trim benefits in order to lessen a rate increase or avoid the increase altogether. This opportunity is explained to the policyowner so that he or she can make an informed decision.

For nearly two decades now, policies include a built-in Contingent Nonforfeiture Benefit, which allows clients to drop coverage if rate increases exceed pre-prescribed amounts. If coverage is let go, premiums paid over time will be used to pay for future long-term care expenses. In other words, the policy is converted into a paid-up policy.

Regarding the claim that policyowners lapse their coverage due to cognitive issues, there are strong consumer protections against such a situation. The NAIC Long-Term Care Insurance Model Act requires the following:

[A] long-term care insurance policy or certificate shall include a provision that provides for reinstatement of coverage in the event of lapse if the insurer is provided proof that the policyholder or certificate holder was cognitively impaired or had a loss of functional capacity before the grace period contained in the policy expired. This option shall be available to the insured if requested within five (5) months after termination and shall allow for the collection of past due premiums, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy and certificate. 

Claim:  A short-term care policy should suffice because most need care in a facility less than seven to nine months.

Fact:  Claims data for 2014 from Genworth Financial, which has more LTC insurance policyholders than anyone in the industry, dispels the idea that policies covering up to nine months leaves a gaping hole in one’s plan for extended care. First, 50% of claims last more than one year, and of those lasting more than one year, the average length of claim lasts 3.9 years. Note also that 71% of claims started with home care; only 16% started in nursing homes. No doubt, long-term care insurance helps people stay at home where they want to be. Yes, the LTC Forum of Colorado, Inc., recommends short-term care insurance coverage to those not healthy enough to purchase LTC insurance or who cannot afford such a policy. But LTC insurance should be the choice for those who can qualify and afford $2,000 to $3,000 per year. In addition, only long-term care insurance can qualify policyowners for the Colorado Partnership Program which allows insureds to protect assets from Medicaid spend-down. For every dollar the Partnership policy pays for care, one dollar in assets is disregarded, allowing the middle class policyholder to leave assets to a spouse, partner, or children.

The story omits other attractive insurance-based planning solutions that are growing in popularity. For example, many life insurance companies now allow the death benefit provided by a life insurance policy to be used or “accelerated” for LTC services. Any remaining death benefit not used for care is paid to the beneficiaries. Premiums may be guaranteed, most offer cash surrender values if the insured cancels coverage, and some allow the monthly benefit received to be used for care from anyone such as family and friends.

Claim: The best solution is a reverse mortgage. No premiums, guaranteed income, and you don’t lose your home. If you are able to age in place at home, you have your house as your insurance policy and that’s the best route to go.

Fact: A home is not an insurance policy. While the LTC Forum endorses and recommends reverse mortgages, such a tool is not for everyone. First, the proceeds from a reverse mortgage may not provide enough income to cover the cost of extended care. Second, the common goal of keeping the house in the family may be compromised. Third, fees and other closing costs can be high.  Lastly, if the home is no longer the primary residence for 12 months, such as needing care in a nursing home or assisted living facility, the loan comes due. Even with these concerns, a very good idea would be to use some of the proceeds to purchase long-term care insurance.

The Forum applauds programs like “Perfect Homecoming” through Lutheran Medical Center and the Senior Resource Center. Certainly, these caring people and institutions play a significant role in discharge, care coordination, meals, and other services. However, the Forum is concerned that Colorado consumers might be led to believe that such programs negate the need for long-term care insurance, or even short-term care insurance. The story simply left out the fact that the patient returning home still needs to pay for home health care services, which is the role of insurance. And if the patient cannot transition back to home and needs care in a facility, the patient and the family will either be thankful for having quality long-term care insurance in place or will desperately wish they had the coverage!

Simply put, needing long-term care is the greatest uninsured risk left in life – more than 50% of people who reach 65 are expected to need care someday. Without any coverage, the caregiver, usually a spouse or child, will often go through severe emotional and physical consequences. For most, the retirement plan and other savings will be depleted to pay for care instead of providing lifestyle and keeping continuing commitments to loved ones. The members of the LTC Forum of Colorado strongly believe that some coverage is better than no coverage!

We would very much welcome the opportunity to visit with 9News about the issues above and additional insurance-based solutions.

Thank you,

The Members of the LTC Forum of Colorado, Inc.

Aaron R Eisenach, CLTC, President
Tammey Sullivan, CLTC, Vice President
Christine Crowley, CLTC, Treasurer
Janet Van Dorn, CLU, CLTC, Secretary
James Eby
Joyce Fowler, CLTC
Paul Hallmark, CLTC
Ralph Leisle, CLU, ChFC, CASL
Tom Rasmussen, CLTC
Don Rhoades
Ray Smith, CLU, CLTC, MBA

For contact information, please visit www.LTCForumColorado.org/members

 

Aaron R. Eisenach has specialized in long-term care planning and insurance-based solutions for 20 years. His passion for this topic stems from losing both his father and grandfather to Alzheimer’s Disease. As an insurance wholesaler, Mr. Eisenach represents ICB, Inc., the nation’s first general agency specializing in LTC insurance. As an educator, he provides workshops to consumers and teaches state-mandated continuing education courses to Colorado insurance agents selling LTC products. As a broker, Mr. Eisenach is the proprietor of AaronEisenach.com and partners with financial advisors and agents who trust him to work with their clients. He is the immediate past president of the Producers Advisory Council at the Colorado Division of Insurance, serves as president of the nonprofit LTC Forum of Colorado, Inc, and has appeared on 9News and KMGH Channel 7. He recently served as an expert witness in a court case and was a contributing author to the American College curriculum on long-term care insurance.

Colorado Court of Appeals: Settlement Including Reduction for MedPay Amounts Enforceable Post-Calderon

The Colorado Court of Appeals issued its opinion in Arline v. State Farm Mutual Insurance Co. on Thursday, May 31, 2018.

Uninsured/Underinsured Settlement and Release Agreement—C.R.C.P. 12(b)(1) Dismissal.

Arline submitted claims to American Family Mutual Insurance Company (American) under insurance policies that provided $5,000 in MedPay coverage and $50,000 in individual underinsured motorist (UIM) coverage. American paid $5,000 in MedPay benefits on Arline’s behalf and negotiated Arline’s damages under her UIM coverage to be $27,000, after subtracting the $5,000 in MedPay benefits already paid. In November 2015, Arline, represented by counsel, accepted the $27,000 payment and signed a release agreement (Agreement) releasing American under the UIM policy.

In November 2016, the Colorado Supreme Court held for the first time in Calderon v. American Family Mutual Insurance Co., 2016 CO 72, that C.R.S. § 10-4-609(1)(c) prohibits insurers from reducing the UIM benefits paid on a claim by the amount of MedPay benefits paid on that claim, which the court deemed a “setoff.” (Counsel in that case now represents Arline.)  Arline then sued American for breach of contract and seeking class certification, asserting that American had unlawfully reduced UIM payments using a MedPay setoff. American responded that the Agreement was a complete bar to the cause of action and moved to dismiss. The district court found the Agreement enforceable and granted American’s motion to dismiss for lack of standing.

On appeal, Arline argued that the district court erred in dismissing her complaint because American’s payment pursuant to the Agreement caused her to suffer an injury-in-fact to a legally protected interest. Though the supreme court held that C.R.S. § 10-4-609(1)(c) prohibits policy provisions allowing a setoff from other coverage, it did not hold that the statute extended to settlement agreements. An insured may agree to a settlement and release as long as the terms do not violate statutory prohibitions or public policy. If a release agreement is valid, dismissal of claims encompassed by the agreement is proper. Here, Arline entered into the Agreement voluntarily while represented by counsel who was fully informed that certiorari had been granted in Calderon. She negotiated her damages benefits and agreed that the UIM benefit amount paid compensated her sufficiently to warrant releasing American from any further claims. In addition, Colorado public policy favors the settlement of disputes when the settlement is fairly reached. Arline signed a valid release agreement that is not void as against public policy or prohibited by statute. The district court properly dismissed her claim.

The judgment was affirmed.

Summary provided courtesy of Colorado Lawyer.

Colorado Supreme Court: Attorney Affidavit Did Not Put Privileged Information at Issue, Therefore Privilege Not Waived

The Colorado Supreme Court issued its opinion in In re State Farm Fire & Casualty Co. v. Griggs on Monday, June 4, 2018.

Attorney-Client Privilege—Implied Waiver.

In this original proceeding pursuant to C.A.R. 21, the supreme court reviewed the district court’s determination that petitioner State Farm Fire and Casualty Company impliedly waived the attorney-client privilege protecting communications between it and its former counsel when it submitted an affidavit from that former counsel to rebut factual allegations of discovery misconduct. The court issued a rule to show to cause why the district court’s finding of implied waiver should not be reversed and now makes that rule absolute. The attorney affidavit submitted in this case did not put privileged information at issue by asserting a claim or defense that depends on privileged information or attorney advice. Rather, the affidavit contained only factual statements that were intended to rebut allegations of discovery misconduct. Accordingly, the court concluded that the district court erred in finding that State Farm impliedly waived its attorney-client privilege on the facts presented.

Summary provided courtesy of Colorado Lawyer.

Colorado Supreme Court: “Suicide, Sane or Insane” Means Intentional Commission of Self-Injurious Act

The Colorado Supreme Court issued its opinion in Renfandt v. New York Life Insurance Co. on Monday, June 4, 2018.

Life insurance Policies—Suicide Exclusion Clauses.

In this opinion, the Supreme Court answered a question of state law certified by the U.S. District Court for the District of Colorado. The Court was asked to interpret the meaning of the words “suicide, sane or insane” when used in life insurance policies. The Court concluded that, under Colorado law, a life insurance policy exclusion for “suicide, sane or insane” excludes coverage only if the insured, whether sane or insane at the time, committed an act of self-destruction with the intent to kill himself.

Summary provided courtesy of Colorado Lawyer.

Colorado Supreme Court: One-year Statute of Limitations Does Not Apply to Bad Faith Actions Under C.R.S. § 10-3-1116(1)

The Colorado Supreme Court issued its opinion in Rooftop Restoration, Inc. v. American Family Mutual Insurance Co. on Tuesday, May 29, 2018.

Unreasonable Delay and Denial of Insurance Benefits—Statute of Limitations—Statutory Interpretation.

The supreme court considered a certified question from the U.S. District Court for the District of Colorado. Specifically, the court determined whether the one-year statute of limitations in C.R.S. § 13-80-103(1)(d) governs actions under C.R.S. § 10-3-1116(1), which creates a cause of action to address the unreasonable delay or denial of insurance benefits. The court concluded that the one-year statute of limitations does not apply to actions brought under C.R.S. § 10-3-1116(1) because the legislature did not intend C.R.S. § 10-3-1116(1) to operate as a penalty within the context of the statutory scheme.

The certified question was answered in the negative and the case was returned to the district court for further proceedings.

Summary provided courtesy of Colorado Lawyer.

Colorado Supreme Court: C.R.S. § 10-3-1116(1) Does Not Require Reduction of Damages Award by Amount of Benefits Delayed but Ultimately Paid

The Colorado Supreme Court issued American Family Mutual Insurance Co. v. Barriga on Tuesday, May 29, 2018.

Unreasonable Delay and Denial of Insurance Benefits—Damages.

The supreme court considered the operation of a statutory scheme that prohibits the unreasonable delay or denial of insurance benefits. Specifically, the court considered whether an award of damages under C.R.S. § 10-3-1116(1) must be reduced by an insurance benefit unreasonably delayed but ultimately recovered by an insured outside of a lawsuit. The court held that an award under C.R.S. § 10-3-1116(1) must not be reduced by an amount unreasonably delayed but eventually paid by an insurer because the plain text of the statute provides no basis for such a reduction. The court further concluded that the general rule against double recovery for a single harm does not prohibit a litigant from recovering under claims for both a violation of C.R.S. § 10-3-1116(1) and breach of contract.

The court of appeals’ decision was affirmed.

Summary provided courtesy of Colorado Lawyer.

Colorado Supreme Court: Insurers Have Duty Not to Unreasonably Withhold or Delay Payments, Even Where Other Parts of Claim in Dispute

The Colorado Supreme Court issued its opinion in State Farm Mutual Automobile Insurance Co. v. Fisher on Monday, May 21, 2018.

Insurance—Underinsured Motorist Benefits—Unreasonable Delay/Denial of Payment.

The supreme court held that under C.R.S. § 10-3-1115 insurers have a duty not to unreasonably delay or deny payment of covered benefits, even though other components of an insured’s claim may still be reasonably in dispute. Here, an insurer issued multiple underinsured motorist insurance policies that covered a driver who was injured by an underinsured motorist. Though the insurer agreed that its policies covered the driver’s medical expenses, it refused to pay them because the insurer disputed other amounts (including lost wages) that the driver sought under the policies. A jury found that the insurer violated C.R.S. § 10-3-1115, which provides that an insurer “shall not unreasonably delay or deny payment of a claim for benefits owed to or on behalf of any first-party [insured] claimant.” Because the court of appeals properly upheld the driver’s jury award, the court affirmed its judgment.

Summary provided courtesy of Colorado Lawyer.

Bills Signed Changing Revenge Pornography Crimes, Amending Laws Related to Bicycles Approaching Intersections, and More

On Thurdsay, May 3, 2018, Governor Hickenlooper signed seven bills into law. To date, he has signed 211 bills and sent two to the Secretary of State without a signature. The bills signed Thursday include a bill changing the laws concerning revenge pornography crimes, a bill requiring state agencies to conduct analyses to determine which businesses are not complying with their rules, a bill permitting municipalities to adopt rules concerning bicycles approaching intersections, and more. The bills signed Thursday are summarized here.

  • SB 18-132 – “Concerning a Waiver of Federal Law to Permit Insurance Carriers to Offer Catastrophic Health Plans to Any Individual Residing in Colorado, and, in Connection Therewith, Making an Appropriation,” by Sen. Jim Smallwood and Rep. Chris Kennedy. The bill requires the commissioner of insurance to conduct an actuarial analysis to determine if the sale of catastrophic health plans to Colorado residents 30 years of age and older and not meeting a hardship requirement would result in a reduction in advanced premium tax credits received by Colorado residents or increase the average premiums of individual health plans.
  • SB 18-144 – “Concerning the Regulation of Bicycles Approaching Intersections,” by Sen. Andy Kerr and Reps. Yeulin Willett & Chris Hansen. The bill permits a municipality or county to adopt a local ordinance or resolution regulating the operation of bicycles approaching intersections with stop signs or illuminated red traffic control signals. Under a local regulation, a bicyclist approaching a stop sign must slow to a reasonable speed and, when safe to do so, may proceed through the intersection without stopping. A bicyclist approaching an illuminated red traffic control signal must stop at the intersection and, when safe to do so, may proceed through the intersection.
  • SB 18-177 – “Concerning Procedures when Certain Private Schools Cease Operations,” by Sens. Kevin Priola & Nancy Todd and Reps. Jeff Bridges & Lang Sias. Under existing law, private occupational schools and certain private degree-granting schools are required to provide a bond or other form of surety that is used to facilitate transfer or to provide tuition and fee reimbursement for students in the event that the school closes. When a private occupational school closes, that school’s records must be maintained by the private occupational school board in the Division of Private Occupational Schools. The bill allows the Department of Education to make a claim on a surety bond for reimbursement of actual administrative costs associated with a school closure.
  • HB 18-1193 – “Concerning the Advanced Placement Incentives Pilot Program, and, in Connection Therewith, Making an Appropriation,” by Reps. James Wilson & Barbara McLachlin and Sens. Ray Scott & Rachel Zenzinger. The bill extends the pilot program three years. It requires the Department of Education to report the number of students in the pilot program who enrolled in advanced placement courses during the prior school year and to collect disaggregated data from the advanced placement exam vendor to capture the performance of students who are participating in the pilot program on the end-of-course advanced placement exams.
  • HB 18-1250 – “Concerning an Analysis to Improve Compliance with Departmental Rules by Regulated Businesses,” by Reps. Tracy Kraft-Tharp & Lang Sias and Sen. Kevin Priola. The bill equires each state agency to conduct an analysis of noncompliance with its rules to identify rules with the greatest frequency of noncompliance, rules that generate the greatest amount of fines, how many first-time offenders were given the opportunity to cure a minor violation, and what factors contribute to noncompliance by regulated businesses. The analysis will guide each department on how to improve its education and outreach to regulated businesses on compliance with the department’s rules.
  • HB 18-1257 – “Concerning a Correction to House Bill 16-1316 by Reinserting the Word ‘Not,'” by Rep. Paul Rosenthal and Sen. John Cooke. House Bill 16-1316 amended the venue statute for transferring child welfare proceedings between counties and inadvertently struck the word ‘not’ in one sentence. Due to this error, courts are not allowed to transfer child welfare proceedings between counties after adjudication even though the intent of House Bill 16-1316 was to allow post-adjudication transfers. The bill reinserts the word ‘not’ to allow such transfers.
  • HB 18-1264 – “Concerning Measures to Clarify the Scope of Revenge Porn Criminal Offenses,” by Reps. Dominique Jackson & Terri Carver and Sens. John Cooke & Rhonda Fields. Currently, Colorado criminalizes posting nude images of another person for harassment purposes or for pecuniary gain. The bill adds images of sex acts that may not include nude images, removes the requirement that the defendant intend to inflict serious emotional distress removes as an exception to the crimes that the image relates to a newsworthy event, and clarifies that the images subject to the crimes may be disclosed by law enforcement personnel, human or social services personnel, prosecutors, and court personnel in the course of their normal business.

For a complete list of the governor’s 2018 legislative actions, click here.

Bills Signed Enacting Uniform Trust Code, Creating Civil Rape Shield Law, Helping Preserve Family Units with Parents with Disabilities, and More

On Wednesday, April 25, 2018, Governor Hickenlooper signed nine bills into law. On Thursday, April 26, 2018, he signed five bills into law. To date, he has signed 183 bills and sent one bill to the Secretary of State without a signature. The bills signed Wednesday and Thursday include a bill enacting the Colorado Uniform Trust Code, a bill enacting a civil rape shield statute, a bill amending family preservation safeguards for parents with disabilities, a bill requiring free-standing emergency rooms to post certain consumer notices, and more. The bills signed Wednesday and Thursday are summarized here.

  • SB 18-071 – “Concerning an Extension of the Repeal of the State Substance Abuse Trend and Response Task Force, and, in Connection Therewith, Making an Appropriation,” by Sens. Cheri Jahn & Larry Crowder and Rep. Daneya Esgar. The state substance abuse trend and response task force is scheduled to be repealed effective July 1, 2018. The bill extends the repeal for 10 years to September 1, 2028.
  • SB 18-146 – “Concerning a Requirement that a Freestanding Emergency Department Inform a Person who is Seeking Medical Treatment about the Health Care Options that are Available to the Person, and, in Connection Therewith, Making an Appropriation,” by Sens. John Kefalas & Jim Smallwood and Reps. Lang Sias & Jonathan Singer. The bill requires a freestanding emergency department (FSED), whether operated by a hospital at a separate, off-campus location or operating independently of a hospital system, to provide any individual that enters the FSED seeking treatment a written statement of patient information, which an FSED staff member or health care provider must explain orally.
  • SB 18-154 – “Concerning a Requirement for a Local Juvenile Services Planning Committee to Devise a Plan to Manage Dually Identified Crossover Youth,” by Sen. Rhonda Fields and Rep. Joseph Salazar. The bill requires local juvenile services planning committees to devise a plan to manage dually identified crossover youth. A dually identified crossover youth is a youth involved in both the juvenile justice system and the child welfare system. The plan must contain descriptions and processes.
  • SB 18-169 – “Concerning Offenses Against Witnesses in Noncriminal Proceedings,” by Sen. Bob Gardner and Rep. Terri Carver. The clarifies that the offenses of intimidating a witness or victim and retaliation against a witness or victim apply to witnesses in criminal, civil, and administrative proceedings.
  • SB 18-180 – “Concerning the Colorado Uniform Trust Code,” by Sen. Bob Gardner and Reps. Cole Wist & Matt Gray. The bill enacts the Colorado Uniform Trust Code and repeals many sections of the Colorado Probate Code.
  • SB 18-187 – “Concerning Transferring Marijuana Fibrous Waste for the Purpose of Producing Industrial Fiber Products,” by Sens. Vicki Marble & Jack Tate and Rep. Jeni James Arndt. The bill gives the state licensing authority rule-making authority to address conditions under which a medical or retail marijuana licensee is authorized to transfer marijuana fibrous waste to a person for the purpose of producing only industrial fiber products.
  • HB 18-1104 – “Concerning Family Preservation Safeguards for Parents with Disabilities,” by Rep. Jessie Danielson and Sens. Dominick Moreno & Kent Lambert. The bill establishes that family protection safeguards for a parent or prospective parent with a disability are critical to family preservation and the best interests of the children of Colorado. These safeguards include that a parent’s disability must not serve as a basis for denial or restriction of parenting time or parental responsibilities in a domestic law proceeding, that a parent’s disability must not serve as a basis for denial of participation in a public or private adoption, or for denial of foster care or guardianship, and that the benefits of providing supportive parenting services must be considered by a court when determining parental responsibilities, parenting time, adoption placements, foster care, and guardianship.
  • HB 18-1132 – “Concerning the Amount that the Department of Corrections is Required to Reimburse a County or City and County for the Confinement and Maintenance in a Local Jail of any Person who is Sentenced to a Term of Imprisonment in a Correctional Facility,” by Rep. Dafna Michaelson Jenet and Sen. Larry Crowder. Under current law, the General Assembly establishes in its annual general appropriations bill the amount that the Department of Corrections is required to reimburse any county or city and county for a portion of the expenses and costs incurred by that county or city and county for the confinement and maintenance in a local jail of any person who is sentenced to a term of imprisonment in a correctional facility. The bill states that, to assist the General Assembly in determining such rate of reimbursement, each county and each city and county shall report to the joint budget committee the average cost of confining and maintaining persons in a local jail for more than 72 hours after each such person has been sentenced to the custody of the department.
  • HB 18-1147 – “Concerning the Continuation of the Regulation of People who Modify the Weather, and, in Connection Therewith, Implementing the Sunset Review Recommendations of the Department of Regulatory Agencies,” by Reps. Joann Ginal & Kim Ransom and Sen. Don Coram. The bill continues the regulation of people who modify the weather.
  • HB 18-1211 – “Concerning Controlling Medicaid Fraud,” by Reps. Cole Wist & Mike Foote and Sens. Irene Aguilar & Jim Smallwood. The bill establishes the medicaid fraud control unit in the department of law. The unit is responsible for investigation and prosecution of medicaid fraud and waste, as well as patient abuse, neglect, and exploitation. Prior to initiating a criminal prosecution, the unit must consult with the district attorney of the judicial district where the prosecution would be initiated.
  • HB 18-1237 – “Concerning the Continuation of the Requirements Regarding the Preparation of a Cost-Benefit Analysis as Administered by the Department of Regulatory Agencies, and, in Connection Therewith, Implementing the Recommendations Contained in the 2017 Sunset Report by the Department of Regulatory Agencies,” by Reps. Tracy Kraft-Tharp & Kevin Van Winkle and Sen. Tim Neville. The bill implements the recommendations of the Department of Regulatory Agencies’ sunset review and report on requirements and procedures regarding the preparation of a cost-benefit analysis.
  • HB 18-1243 – “Concerning Enactment of a Civil Rape Shield Law,” by Reps. Mike Foote & Cole Wist and Sens. Don Coram & Rhonda Fields. Under Colorado criminal law there is a rape shield law that presumes that evidence of a victim’s sexual conduct is irrelevant and not admissible except for evidence of the victim’s prior or subsequent sexual conduct with the defendant or evidence of specific instances of sexual activity showing the source or origin of semen, pregnancy, disease, or any similar evidence of sexual intercourse offered for the purpose of showing that the act or acts were or were not committed by the defendant. The bill creates a similar presumption in a civil proceeding involving alleged sexual misconduct. If a party wants to introduce sexual conduct evidence, it must file a confidential motion with the court at least 63 days prior to trial. Prior to ruling on the motion, the court shall conduct an in camera hearing and allow the parties and alleged victim to attend and be heard.
  • HB 18-1275 – “Concerning the Repeal of the Craig Hospital License Plate Donation Requirement,” by Rep. Jeff Bridges and Sen. Daniel Kagan. Current law requires an applicant to make a donation to Craig Hospital in order to be issued a special Craig Hospital license plate. The bill repeals the $20 donation requirement.
  • HB 18-1282 – “Concerning a Requirement that a Health Care Provider Include Certain Identifying Information on all Claims for Reimbursement for Health Care Services,” by Reps. Susan Lontine & Lang Sias and Sens. Jim Smallwood & John Kefalas. The bill requires an off-campus location of a hospital to apply for, obtain, and use on claims for reimbursement for health care services provided at the off-campus location a unique national provider identifier, commonly referred to as NPI. The off-campus location’s NPI must be used on all claims related to health care services provided at that location, regardless of whether the claim is filed through the hospital’s central billing or claims department or through a health care clearinghouse. It also requires all medicaid providers that are entities to obtain and use a unique NPI for each site at which they deliver services and for each provider type that the department of health care policy and financing has specified.

For a complete list of Governor Hickenlooper’s 2018 legislative decisions, click here.

Colorado Court of Appeals: Plaintiff Not Allowed to Treat Denial of Liability as Denial of Coverage

The Colorado Court of Appeals issued its opinion in Pena v. American Family Mutual Insurance Co. on Thursday, April 19, 2018.

Uninsured Motorist—Denial of Liability—Denial of Coverage—CRCP 12(b)(5) Dismissal.

Peña was involved in a three-car collision. Both Peña and Garner, another driver involved in the accident, were insured by defendant American Family Mutual Insurance Company (American Family). Peña sent a letter to American Family asserting a claim under the uninsured motorist provisions of her policy. American Family denied Peña’s claim, asserting that Garner was not responsible for the damage to her vehicle and Garner had coverage at the time of the accident, so Peña’s uninsured motorist property damage (UMPD) provision would not apply.

Peña sued Garner and American Family in separate actions. In this action, she sued American Family under C.R.S. § 10-3-1115 for the unreasonable delay and denial of benefits due under the UMPD provisions of her policy. American Family moved to dismiss, arguing that Peña’s complaint failed, as a matter of law, to state a claim upon which relieve could be granted because Peña’s UMPD coverage applied only if American Family, as Garner’s insurer, denied coverage, rather than liability, for Garner in connection with the accident. The district court agreed with this interpretation of Peña’s policy and the distinction made between denial of coverage and denial of liability. But because American Family had only denied liability and the issue of liability had not yet been determined, the court concluded that Peña’s UMPD coverage did not apply at that point and the lawsuit was premature. The district court dismissed the case without prejudice.

On appeal, Peña contended that the district court erred in dismissing her case. She argued that the district court erred in not considering whether American Family unreasonably delayed or denied her claim before dismissing her action. Because American Family denied liability but not coverage, her policy’s UMPD provision was inapplicable, and there were no benefits that could have been delayed or denied. Peña had no claim as a matter of law. The district court’s determination that Peña’s lawsuit was premature was in error because Peña will never have a claim against American Family under her policy for unpaid UMPD benefits from the accident; Garner’s insurer has not denied coverage, which is the circumstance that would trigger Peña’s UMPD coverage. If Garner is ultimately found liable, Peña will have a claim against American Family under the liability provisions of his policy.

The judgment was affirmed.

Summary provided courtesy of Colorado Lawyer.

Bills Signed Requiring Commercial Drivers to Receive Training in Human Trafficking Prevention, Modifying Water Court Process for Substitute Water Rights, and More

On Thursday, April 12, 2018, Governor Hickenlooper signed 23 bills into law. To date, he has signed 149 bills and sent one to the Secretary of State without a signature. Some of the bills signed Thursday include a bill allowing a water court process for mitigation measures, a bill requiring commercial drivers to receive training on prevention of human trafficking, a bill authorizing insurers’ agents to access the electronic motor vehicle title database, and more. The bills signed Thursday are summarized here.

  • SB 18-011 – “Concerning Treatment of Students who are Excused by their Parents from Participating in State Assessments,” by Sens. Chris Holbert & Andy Kerr and Reps. Tracy Kraft-Tharp & Paul Lundeen. The bill clarifies procedures for parents who excuse their children from taking state assessments and students whose parents excuse them from testing shall still be allowed to receive rewards designed for students who complete the assessments.
  • SB 18-079 – “Concerning Classifying Sake as a Vinous Liquor for the Purposes of the ‘Colorado Liquor Code,'” by Sen. Lucia Guzman and Rep. Dan Pabon. The bill classifies sake as a vinous liquor (wine) for the purposes of the “Colorado Liquor Code.”
  • SB 18-087 – “Concerning In-state Tuition at Institutions of Higher Education for Certain Foreign Nationals Legally Settled in Colorado,” by Sen. Stephen Fenberg and Reps. Dafna Michaelson Jenet & Faith Winter. The bill contains a legislative declaration about the circumstances facing special immigrants and refugees and the benefit of access to education.
  • SB 18-106 – “Concerning Obsolete Statutory Provisions Related to a Local Government’s Pledging of Sales or Use Tax Revenues to Pay for Revenue Bonds Issued for the Purpose of Financing Capital Improvements,” by Sen. Jack Tate and Rep. Don Thurlow. Current law specifies that a county, city, or incorporated town may include the creation of a sales and use tax capital improvement fund (special fund) when the county, city, or incorporated town seeks voter approval to levy a sales or use tax. The creation of the special fund does not have a purpose for a county, city, or incorporated town post-TABOR because the question of using sales or use tax revenues for financing capital improvements is asked when the county, city, or incorporated town seeks voter approval for the bond issuance. Thus, the language regarding the creation of the fund is unnecessary.
  • SB 18-110 – “Concerning the Repeal of the Requirement that Each State Agency Annually Report the Amount of Federal Money it Received in the Prior Fiscal Year,” by Sen. Jack Tate and Rep. Jeni James Arndt. During the 2017 legislative session, the statutory revision committee put forth House Bill 17-1058, which, in part, repealed a requirement that the state controller submit to the general assembly a report of all federal money received by state agencies during the prior fiscal year. State agencies are still required to submit an annual report to the state controller of all federal moneys received by the state agency in the prior fiscal year for the state controller’s use in preparing the report for the general assembly.The bill repeals the state agency reporting requirement as the state controller is no longer required to prepare a report for the general assembly.
  • SB 18-127 – “Concerning the Repeal of the Department of Revenue’s Requirement to Publish an Historical Explanation of Income Tax Rate Modifications Enacted in the State on Every Income Tax Return Form,” by Sen. Beth Martinez Humenik and Rep. Dan Thurlow. The bill repeals the requirement that the Executive Director of the Department of Revenue publish an historical explanation of income tax rate modifications enacted in the state on every income tax return form.
  • SB 18-129 – “Concerning the Nonsubstantive Reorganization of the Law Exempting from State Sales Tax Certain Drugs and Medical and Therapeutic Devices,” by Sen. Dominick Moreno and Rep. Jeni James Arndt. The bill makes several modifications to the laws exempting certain drugs and medical devices from sales tax.
  • SB 18-136 – “Concerning Fees for Advising Clients About the Selection of an Individual Health Benefit Plan,” by Sen. Tim Neville and Reps. Tracy Kraft-Tharp & Lang Sias. The bill allows an insurance producer or broker advising a client on individual health benefit plans to charge the client a fee if the producer or broker does not receive a commission related to the individual health benefit plan selected by the client and if the producer or broker discloses in writing the fee to the client.
  • SB 18-161 – “Concerning Repeal of the Behavioral Health Transformation Council,” by Sen. Jim Smallwood and Reps. Tracy Kraft-Tharp & Lois Landgraf. The bill repeals the behavioral health transformation council.
  • SB 18-162 – “Concerning Substitute Child Care Providers,” by Sen. Beth Martinez Humenik and Reps. Janet Buckner & James Wilson. The bill creates a license within the Department of Human Services for a substitute placement agency that places or that facilitates or arranges placement of substitute child care providers in licensed child care facilities providing less than 24-hour care.
  • SB 18-170 – “Concerning a Water Court Process by Which an Owner of a Storage Water Right Allowing Water to be Stored in New Reservoir Capacity may Release Water into an Identified Stream Reach in a Manner that Protects the Water Releases while Complying with Mitigation Measures Identified in a Fish and Wildlife Mitigation Plan Approved by the Colorado Water Conservation Board,” by Sen. Jerry Sonnenberg and Reps. Chris Hansen & Hugh McKean. The bill establishes a water court process by which an owner of a water storage right allowing water to be stored in a newly constructed reservoir or an enlarged existing reservoir may comply with the mitigation measures identified in a mitigation plan by contracting with the board.
  • SB 18-172 – “Concerning Testing of Horse Racing Licensees for the Presence of Prohibited Substances,” by Sen. Bob Gardner and Rep. Pete Lee. The bill adds to the responsibilities of the Colorado racing commission the protection of all participants, human and animal, involved in horse racing.
  • SB 18-176 – “Concerning Changes to the Requirements for Meeting Dates for the Board of the Southwestern Water Conservation District,” by Sen. Don Coram and Reps. Barbara McLachlin & Marc Catlin. The bill requires the Board of the Southwestern Water Conservation District to meet once every three months and makes amendments to the terms of the board members and board president.
  • SB 18-182 – “Concerning the Authority to Allocate a Portion of the Source Market Fee to Statutorily Authorized Purse Funds,” by Sens. Don Coram & Lucia Guzman and Reps. Marc Catlin & Jeni James Arndt. Current law requires persons outside of Colorado who accept wagers from residents of Colorado on simulcast horse racing events to be licensed in Colorado and to pay a source market fee into the racing cash fund. The bill authorizes the Director of the Division of Racing Events to allocate a portion of the source market fee to be paid to any horse purse trust fund established pursuant to existing law, if necessary, to maintain a sustainable and competitive purse structure in Colorado.
  • SB 18-183 – “Concerning Authorizing Agents of Insurers to Access the Electronic System that Insurers Access for Owner and Lienholder Information of a Motor Vehicle,” by Sen. Jack Tate and Reps. Jeni James Arndt & Larry Liston. Current law authorizes the creation and maintenance of an electronic system that vehicle towers, insurers, and salvage pools may use to access motor vehicle title records if the vehicle is insured or possessed by those entities. The bill allows an agent of an insurer to use the system in the same circumstances.
  • SB 18-184 – “Concerning a New Permit for the Short-term Extraction of Construction Materials,” by Sen. Don Coram and Reps. Hugh McKean & Daneya Esgar. The bill creates a new class of limited impact construction materials permits for one-time activities that produce construction materials as a by-product and are not intended to be ongoing mining operations and authorizes an application fee of $400 for the permit and an annual fee of $200.
  • HB 18-1017 – “Concerning the Adoption of an Interstate Compact to Allow a Person Authorized to Practice Psychology in a Compact State in Which the Person is not Licensed, and, in Connection Therewith, Making an Appropriation,” by Rep. Dafna Michelson Jenet and Sens. Bon Gardner & Stephen Fenberg. The bill enacts the ‘Psychology Interjurisdictional Compact Act’ allowing psychologists licensed in any compact state to provide telepsychology services to clients in any other compact state, or temporary in-person client services in any compact state not exceeding 30 days in a calendar year.
  • HB 18-1018 – “Concerning a Requirement that Education to Prevent Human Trafficking be Included in the Training to Obtain a Commercial Driver’s License,” by Reps. Terri Carver & Dominique Jackson and Sens. Rachel Zenzinger & John Cooke. The bill requires that the training to obtain a commercial driver’s license to drive a combination vehicle contain education to prevent human trafficking if the training is conducted in a driving school. The department must also publish information about human trafficking for commercial driver’s license holders and trainees.
  • HB 18-1049 – “Concerning the Department of Human Services’ Authority to Continue to Lease Portions of the Grand Junction Regional Center Campus to Third-party Behavioral Health Providers,” by Rep. Dan Thurlow and Sen. Ray Scott. The Department of Human Services currently leases portions of the Grand Junction regional center campus to third-party behavioral health providers. The bill authorizes the Department to continue such leases until June 30, 2020, and each party to such lease may terminate the lease early provided that the terminating party provide the other party with 90 days notice before vacating the property or requiring the property to be vacated.
  • HB 18-1056 – “Concerning the Statewide Standard Health History Form that Members of the Fire and Police Pension Association Complete when Commencing Employment,” by Reps. Kevin Van Winkle & Dave Williams and Sen. John Cooke. Every member of the fire and police pension association (FPPA), at the commencement of employment, is required to complete a health history on a statewide standard health history form. The bill clarifies several aspects of the form.
  • HB 18-1078 – “Concerning Court Programs for Defendants who have Served in the Armed Forces,” by Reps. Lois Landgraf & Tony Exum and Sen. Bob Gardner. Under current law, the chief judge of a judicial district may establish an appropriate program for the treatment of veterans and members of the military. The bill states that, in establishing any such program, the chief judge, in collaboration with the probation department, the district attorney, and the state public defender, shall establish program guidelines and eligibility criteria. The bill requires a court, in determining whether to issue an order to seal criminal records of a petitioner who has successfully completed a veterans treatment program, to consider such factor favorably in making the determination.
  • HB 18-1154 – “Concerning Consumer Protections Relating to a Solicitation to Provide a Copy of a Public Record for a Fee,” by Reps. Edie Hooten & Kevin Van Winkle and Sen. Cheri Jahn. The bill requires a person who solicits a fee for providing a copy of a deed or deed of trust to give a copy of the document that will be used for the solicitation to each county clerk and recorder where the solicitation is to be distributed; not charge a fee of more than 4 times the amount charged by the county clerk and recorder; and include specified disclosures.
  • HB 18-1239 – “Concerning Continuation under the Sunset Law of the Environmental Management System Permit Program, and, in Connection Therewith, Implementing the Recommendations of the Sunset Report by the Department of Regulatory Agencies by Allowing the Program to Repeal,” by Rep. Lois Landgraf and Sen. Ray Scott. The bill implements the recommendations of the sunset review and report on the environmental management system permit program by allowing the program to repeal.

For a complete list of Governor Hickenlooper’s 2018 legislative decisions, click here.

Colorado Court of Appeals: Excess Insurer Must Step Into Shoes of Insured and Plead Primary Bad Faith

The Colorado Court of Appeals issued its opinion in Preferred Professional Insurance Co. v. The Doctors Co. on Thursday, April 5, 2018.

Medical Malpractice—Primary Insurance Policy—Excess Insurance Policy—Equitable Subrogation —Bad Faith.

A medical malpractice suit was filed against Dr. Singh and other parties. The Doctors Company (TDC), the primary insurer, defended Dr. Singh in the suit as required by its primary liability policy. Preferred Professional Insurance Company’s (PPIC) insurance policy was an “excess policy,” which would cover any losses that exceeded TDC’s $1 million coverage up to an additional $1 million. As an excess insurer, PPIC did not have any duty to defend Dr. Singh in the suit. The plaintiff in the medical malpractice suit offered to settle the case with Dr. Singh for $1 million, the amount of TDC’s policy limits. Dr. Singh conveyed his desire to accept the settlement offer to both insurers, but TDC declined to settle the case. PPIC told Dr. Singh he should accept, and it paid the $1 million settlement. PPIC then filed suit against TDC for equitable subrogation to recover the amount paid. The district court granted summary judgment in PPIC’s favor without addressing TDC’s argument that PPIC was required to prove that TDC refused to settle in bad faith.

On appeal, TDC contended that the district court erred as a matter of law because an equitable subrogation claim brought by an excess insurer against the primary insurer to recover the amount paid in settlement can only be derivative of the insured’s rights. Thus, PPIC’s refusal to plead and present evidence that TDC acted in bad faith in declining to settle required dismissal of PPIC’s claim. An excess insurer seeking recovery under equitable subrogation for a primary insurer’s failure to settle a case against their mutual insured “steps in the shoes of the insured” and must plead and prove the primary insurer’s bad faith. Here, without an assertion that TDC acted in bad faith, PPIC’s equitable subrogation claim is not legally viable.

The order granting summary judgment for PPIC was reversed and the case was remanded for entry of judgment of dismissal in TDC’s favor.

Summary provided courtesy of Colorado Lawyer.