Support Assembly Bill 1868 to Remove Discretionary Clauses from Group Insurance Policies

We are encouraging all interested parties to read and support Assembly Bill 1868 sponsored by California Assembly Member David Jones. This bill, if passed, would return fairness to a system which has been stacked in favor of insurance companies for too long. The insurance lobby, as expected, is putting up a fierce fight in order to prevent the passing of AB 1868. This is why we are reaching out to the fibromyalgia community.

Sample letter text:

Dear _______________:

I am writing you today both as a California citizen and voter, and as an individual who suffers from a debilitating illness. Due to the effects of my illness, I, along with many others in my situation, have been forced to leave the work force and go out on medical disability. Unfortunately, I have learned a great deal about how difficult it is to receive long term disability benefits through coverage provided to me by my employer. Because my benefits are employer provided, my claims for benefits, and any litigation stemming from the denial of any claims I submit, are governed by Federal Employee Retirement Income Security Act of 1974 ("ERISA").

As a result of the Federal Courts' interpretation of the ERISA statute, when insurance companies insert language into the policies vesting themselves with discretion to decide claims, the Federal judges who review denials will give substantial deference to the insurer's decision. This means the judge will not be determining if the claimant is entitled to benefits, but will rather be looking to see if the denial was "arbitrary or capricious," and will ignore the merits of the claim. Any standard of review that ignores the merits of an individual's claim is inherently unjust. Such a standard leaves an already vulnerable group of individuals less able to obtain the disability benefits they both desperately need and rightfully deserve. It is an exceedingly unfair and unreasonable interpretation of a statute, which does not align with the concepts of fairness and justice.

That is why I support Assembly Bill 1868, introduced by Assemblymember David Jones. This legislation, which bans discretionary clauses in group long-term disability policies, would create an even playing field for insurance claimants and could help dissuade insurance companies from unfairly denying claims. This, in turn, would help many people with fibromyalgia and other conditions who rely on disability benefits to pay their bills when they cannot work.

Without these protections against discretionary clauses, insurance companies who deny valid disability claims have a completely unfair advantage, and thus, will more often than not succeed in denying valid claims. With the protection in AB 1868, insurers will be incentivized to review claims more thoroughly, which will even the playing field somewhat and reduce the need for an employee to resort to the legal system. Here in California, prohibiting discretionary clauses will make the standard of court review for group policies purchased by an employer the same as it already is for individual policies.

I strongly urge the State of California to pass Assembly Bill 1868 to rid California residents of the burden of discretionary clauses. Given the strength of the insurance lobby's expected opposition, your support is vital to AB 1868's success. I thank you for your service to the people of California, and look forward to your response.



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