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  • Writer's pictureThe San Juan Daily Star

Bill would penalize insurance companies that deny coverage

Rep. Jorge Navarro Suárez

By The Star Staff

Insurance companies that deny coverage to individuals without any legal justification could face criminal liability under legislation proposed by Rep. Jorge Navarro Suárez on Monday.

House Bill 2031 would classify as a felony the practice of insurers of denying coverage to patients without legal or contractual justification.

According to the lawmaker, the purpose of the bill is to penalize fraud through trickery, simulation, plot or any form of deception to deny services to policyholders who are eligible for medical coverage.

“Currently, laws seek to protect citizens against insurance practices and abuses. However, there is a practice that undermines confidence in the health insurance industry,” Navarro Suárez said. “Insurers deny medical or drug coverage to avoid the expense of offering that service. That’s what I call fraud.”

The legislative measure prohibits an insurer from denying or refusing payment for medical coverage without legal justification or without basis in the policy through ruse, simulation, plot, trick or by any form of deception.

Such an act would be considered fraud against the insured and would be sanctioned with a sentence of imprisonment for a fixed term of two years, or a fine that would not exceed $10,000, according to the bill. Additionally, any person who holds a management, administrative position or decision-making position within the structure of an insurance company that authorizes, consents to, participates in or in any way gets involved in the commission of the crime of fraud against the insured would be held accountable for the crime and subject to the same sanctions established for the insurer.

The legislator added that “there are laws that criminalize fraud of providers or patients against insurers.”

“Likewise, there must be statutes that criminally penalize the criminal conduct of the insurers,” he said.

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