Is The Personal Injury Fraud Claims By Insurers A Rouse To Hide Corporate Profits

 For years personal injury insurance companies have been claiming fraud is getting more and more out of hand. Over the past several years, even with an incredibly poor economy we've seen companies like State Farm have record setting profits of $800 Million in 2009 and $1.2 Billion in 2010.

So with these claims come suspicion as to their motivation. Why would a company and an industry that's doing so well and so profitable claim fraud is killing their profits and causing greater losses to their company??

Profits. Pure and simple.

According to some, the claims of fraud are a "smokescreen to hide padded profits".

This wouldn't be the first time the public trust has been compromised, politicians in hand in order for corporate profits (anyone remember Fannie & Freddie??).

Read more in this great article entitled: Claude Hanuschak: PIP fraud is exaggerated

So when the politicians start with the TV and Radio ads blaming your local doctors and attorneys, remember this blog post and Claude's words... PIP Fraud Is Exaggerated; all because they want to charge YOU higher premiums!

New Insurance Tactics: Intimidating Doctors that Supports Plaintiffs’ Injuries

Mark Bello

Allstate Insurance Company is seeking to recover $5 million in its fourth insurance fraud lawsuit of 2011. The company said it is seeking reimbursement for personal injury protection benefits that it paid on behalf of its customers.

The lawsuit alleges that New York medical professional corporations were fraudulently incorporated using the names of licensed physicians although laypersons actually owned and controlled the corporations; it is a violation under New York law for non-medical professionals to own a medical company. Allstate also contends that the laypersons submitted fraudulent insurance claims for unnecessary medical tests. The claims were filed under patients' insurance policies as "no-fault” which would allow Allstate to quickly pay injured policyholders for their injuries without going to court. Since 2003, Allstate has filed 31 fraud lawsuits in New York, seeking more than $170 million in damages.

Allstate would have us believe that New York is in an insurance fraud crisis and no-fault fraud is costing New Yorkers hundreds of millions of dollars each year. Krista Conte, spokesperson for Allstate's New York office, said “we need lawmakers to enact meaningful “insurance reform” (buzz word for another corporate bailout for billion dollar insurance companies) that puts the citizens of New York first."
Not so fast, ladies and gentlemen; the problem is that Allstate has no credibility on these issues. Since when has this anti-citizen company ever put citizens first? Allstate has always put its’ profits over the interest of its policy holders, ALWAYS. What Allstate is attempting to do here is to intimidate those doctors who have the audacity to actually put the interests of injured citizens first and Allstate profits second. This is the same “delay, deny, confuse and refuse” tactic that Allstate has used for years in defending personal injury claims. Instead of taking on its citizen/policy holders directly in litigation (where it usually loses), to “delay, deny, confuse and refuse”, it is now attacking those doctors who treat (rather than whore their services to Allstate so that claims can be denied) patients who happen to be insured by the “good hands people”. Those in the know call the company “Allsnake”.

Was Allstate dealt the same “bad hand” they deal their policy holders? Unlike what Allstate wants the general public to believe, fraud in the insurance industry in not a one-way street. While claims fraud should be addressed, Allstate’s “good hands” need to be thoroughly washed to clean the filth of unreasonableness and dishonest claims handling perpetrated on its own policy holders and those its policy holders seriously injure.

This is how Allstate’s (and other insurance companies’) deceptive tactics work: A policy holder files a no-fault claim or an injury victim files a tort claim. Allstate hires its own doctors, which the company calls Independent Medical Examiners (IMEs) to perform an examination of the plaintiff and review medical records and tests. The IME will also testify at trial, if necessary. If these physicians were truly “independent”, this might be a reasonable way to evaluate the validity of a claim. Unfortunately that is not the case; Allstate (and its ilk) retain the services of the same doctors in communities all across the country and instruct them to perform “cursory” evaluations of injury victims, typically lasting no more than 15 minutes to a half hour. These doctors are rarely in current practice (often retired), often do only defense exams, and are paid millions of dollars a year to produce negative results. Millions of dollars added to the cost of litigation (instead of toward the compensation of the victims) are used to pay doctors for hire, whose sole purpose is to provide test results and testimony that plaintiffs have not suffered injuries or that the accidents at issue did not cause their health problems. This tactic gives Allstate “cover” when it denies a claim and forces litigation. A “win at all cost” mentality exists, even if it means mistreating its own policy holders.


Allstate has made an art form of manipulating the justice system to rake injury victims and its own policy holders out billions of dollars, first through denying, delaying, and defending legitimate lawsuits, then low-balling the victims that its tactics have made financially desperate. And now, its new tactic is to claim that insured’s and their treating doctors are defrauding the company.


If you are injured in an auto accident, Allstate will likely challenge your claim, drag you into court, and take as long as possible, often years, before making an offer; an offer that is usually significantly less than the value of your claim. You are in “Greedy Hands with Allstate”; this is a company that believes its money is better spent dragging innocent victims through court rather than helping them in a time of need. Remember, the bottom line for Allstate is profit, profit, and more profit.


Tactics like this “fraud lawsuit” are designed to intimidate treating doctors and send a message that cases are “frivolous” and claims are “fraudulent”; the reality is that the tactics of Allstate and other insurance companies that engage in similar claims avoidance conduct are far more costly to the litigation process than anything done on the claimant side. Politicians should be screaming about “frivolous defenses”, not about so-called “frivolous lawsuits”. One case at a time, one jury at a time, a trial lawyer can attack these tactics, expose corporate greed, and show each jury that bought and paid for medical testimony is, simply, not credible. Trial results often reflect that. But public spectacles like the effort in New York put “fraud” and “frivolous” in the minds of the public (prospective jurors) and it is hard to compete, financially, with billion dollar insurance companies and other industries that would rather spend profits on phony “lawsuit abuse” campaigns that pay seriously injured accident victims. And until the general public wakes up and realizes the wool is being pulled over its eyes, access to justice for our fellow citizens will continue to be denied.


Imagine being seriously injured; you visit an emergency room or your family doctor. You are referred to a specialist and incur thousands of dollars in medical treatment expenses. You submit the claim to your own insurance company (the one you have been paying premiums to for years, despite a spotless claims record) only to have the claim denied because the company sent you to its so-called “expert”, and paid this “independent doctor” a significant amount of money to favor the insurance company’s position on the claim. The defense exams are for the sole purpose of a “little or nothing is wrong” diagnosis. My friends, what is your definition of “fraud”?


Using phrases like “lawsuit abuse”, “citizens against lawsuit abuse”, “tort reform”, “liability reform”, “frivolous lawsuit”, “jackpot justice”, and “insurance reform”, these companies and their lobbying arm, the U.S. Chamber of Commerce are falsely linking personal injury litigation to the cost of health care in this country. In reality, litigation is an irrelevant percentage of the overall cost of healthcare. Google ™ any legitimate, independent, study (not one by trial lawyers, insurance companies, or corporate interests), those conducted by or for Public Citizen, for example, on this issue and you will find that industry claims of any kind of litigation crisis in America is an absolute myth. You will find that the cost of litigation in relation to health care is miniscule. Corporate interests are pumping millions (instead of paying appropriate benefits to policy holders) in a deceptive marketing campaign and into the political campaigns of conservative politicians like Rick Perry and Mitt Romney to say that “corporations are people” and need our assistance against the “greedy trial lawyers”. This, of course, is nonsense, but it has had some success, especially in the political arena, where some politicians will cozy up to the devil himself if it means a steady flow of campaign dollars.


So, how do you stop this corporate takeover of our civil justice system? How do you prevent insurance companies from deceiving its policy holders? How do you prevent corporate interests and their political hacks from trampling on your constitutional rights? With you voice and with you vote; that is how you must beat them. And you should act before you become an accident victim, forced to go toe to toe with an insurance company that will use its economic power (achieved with your premium dollars) to crush you. Contact your local, state and federal elected representatives; find out where they stand on these important issues. If they stand with the corporations and the tort reformers, tell them they can’t have your vote. And if they refuse to see things your way, vote for the “other guy”. Together, we must combat and put an end to the deceptive corporate takeover of our precious civil justice system.

Reference: http://southfield.injuryboard.com/miscellaneous/new-insurance-tactics-intimidate-doctors-who-provide-reports-and-treatment-that-supports-plaintiffs-injuries.aspx?googleid=293730

Mark Bello has thirty-three years experience as a trial lawyer and twelve years as an underwriter and situational analyst in the lawsuit funding industry. He is the owner and founder of Lawsuit Financial Corporation which helps provide legal finance cash flow solutions and consulting when necessities of life litigation funding is needed by plaintiffs involved in pending, personal injury litigation. Bello is a Justice Pac member of the American Association for Justice, Sustaining and Justice Pac member of the Michigan Association for Justice, Business Associate of the Florida, Tennessee, and Colorado Associations for Justice, a member of the American Bar Association as well as their ABA Advisory Committee, the State Bar of Michigan and the Injury Board.

Florida PIP; One Newspaper Call For Repairs - Not Replacement.

The Orlando Sentinel weighs in on the upcoming battle that will surely pit the big business auto insurers against your local doctor and, if you drive a car, against you.

Pointing out that if you "Remove the PIP requirement, motorists will pay substantially more for their health insurance, which increasingly would cover auto injuries. More deadbeats also will drive without insurance, forcing others to pay for their care after accidents".

The Orlando Sentinel is calling for repairs of the PIP system, not replacing the system with something else. "Where it looks like you'll save on auto insurance, you'll end up paying more for health insurance", points out the newspaper.

The auto insurers also would love to replace a diminished personal injury protection (PIP) system with one mandating more expensive — and more profitable — bodily-injury protection.  Let's remember, this is big business and it's all about big profits.  Under the current system, last year (2010) State Farm's profits surpassed the billion dollar mark, up from $900 million in 2009.

So, with profits so high why all the complaints? Well, quite frankly it's a chance to change the rules of the game to favor big insurance even greater than they do now.

The Orlando Sentinel has it right, don't scrap the current PIP program, rather have our legislators roll up their sleeves and fix what's broken in the current system.  And, quite frankly it's not much. No matter what business, industry or profession, you will find a few bad apples.  But to throw out an entire basket of good apples because there are a few bad ones seems like a waste of a lot of good apples.  It's time for our legislature to pick out the bad apples and find out how they got there, then fix that part of the system.

If you had one bad employee would you close your business? or would you retrain or even re-hire a new one?

For more on the Orlando Sentenal's sentiments, click here for their entire article.

FPIB

PIP Benefits Cannot Be Denied If Patient Doesn't Show for IME or EUO-Florida Supreme Court Denies United Auto Rehearing

Tuesday, May 24, 2011

Florida Supreme Court Denies Rehearing of its Opinion in Custer Medical Center v. UAIC - United Automobile Insurance Company

On May 18, 2011, the Supreme Court of Florida entered an order denying United Automobile Insurance Company's ("UAIC") motion for rehearing and request for oral argument in Custer Medical Center v. United Automobile Insurance Company, 2010 WL 4340809 (Fla. Nov. 4, 2010) (Case No. Sc08-2036). The Court contemporaneously entered additional orders relating to ancillary motions and amici briefs. One of the Court's orders struck all amici briefs filed in the case, including briefs filed by numerous industry trade associations, insurance companies, and even the NCIB. Other orders denied motions filed in the case which were rendered moot by the court's denial of UAIC's motion for rehearing.
The Custer opinion, issued on November 4, 2010, contained language ancillary to the case's holding, known as dicta, that frustrates the purpose of the anti-fraud provisions of the personal injury protection ("PIP") statutes. The dicta opined that:

• PIP policy provisions that do not directly mirror the PIP statutes may be unenforceable.

• Unless otherwise provided by statute, a PIP carrier may not deny payment of medical expenses incurred and submitted by the insured prior to the date of a scheduled independent medical exam ("IME"), even if an insured does not attend the IME.

• Unless otherwise provided by statute, a PIP carrier may only deny payment of an insured's medical expenses incurred and submitted after the date of the IME if the carrier can affirmatively prove the unreasonableness of an insured's failure to attend an IME. Thus, the burden of proving the unreasonableness of the insured's action/non-action rests with the insurer.

• Denial of benefits for an insured's failure to submit to an examination under oath without counsel ("EUO") may no longer be permissible, as the Court points out that EUOs are not expressly permitted under the PIP statutes.

Denial of UAIC's motion for rehearing cements the Custer decision into our lawbooks, creating uncertainty for PIP insurers in Florida. The full effects of the Supreme Court's decision today are yet to be determined, but the use of IMEs and EUOs may be significantly impaired due to litigation contesting the use of these fraud fighting tools.

PIP 'Reforms' Disguise Insurance Industry Profit Grab

Reprinted / reposted from: http://www.sunshinestatenews.com/story/pip-reforms-disguise-insurance-industry-profit-grab

 

 

Proposed legislation writes loopholes into the law to help insurers

Recently, I read a commentary on your site from yet another special-interest group funded by the powerful insurance industry, with a name that sounds as if they are looking out for the interests of Florida’s consumers.

Your readers need to understand, however, that these so-called “consumer groups” are part of the insurance industry’s public relations engine, which is using the seemingly admirable mantra of reducing PIP fraud to disguise their real intentions of making it easier to delay or deny payments on legitimate PIP claims.

The statistics that often are cited are misleading at best. Let’s be clear: PIP fraud is wrong and must be stopped; but Florida consumers are being blatantly misled by these various consumer groups proclaiming that PIP fraud is rampant and is costing all Floridians significantly in what they pay for PIP.
Insurance companies are continuing to earn record profits, and they are continuing to look for ways to reduce what they pay for legitimate PIP claims. And, contrary to representations made by the various consumer groups, PIP premiums have not gone up in years. Clearly, there is no shortage of insurers fighting for your business – just take notice of all the advertisements and solicitations consumers see every day.

To fuel the uproar, consumer groups keep telling us that PIP fraud is rampant because “questionable claims” in Florida are on the rise. But, has anyone ever stopped to ask what a questionable claim really is?

The term most frequently used is in conjunction with data from the National Insurance Crime Bureau (NICB). As the NICB would confirm, questionable claims are simply initial claims referred to them from their member insurance companies based on what those companies believe to be "questionable" or "suspicious." Such claims are not yet determined to be definitive acts of fraud.

In addition, it is significant to point out that when the number of PIP questionable claims in Florida, according to a March 22 NICB report, is compared to the total number of crashes in Florida (as compiled by the Florida Department of Highway Safety and Motor Vehicles), PIP questionable claims represent less than 1 percent of all crashes (2009: NICB – 2,347 PIP QCs/FLHSMV – 235,778 crashes). And, it is important to keep in mind that data from the Florida Division of Insurance Fraud show that only 4 percent of all reported possible PIP fraud claims it receives (about 5,500) result in prosecution.

So, is PIP fraud really as rampant as insurance companies want all of us to believe? No, it is not.

Some provisions in the proposed PIP legislation have nothing to do with fighting fraud and will instead create a potentially unreasonable burden for medical providers and policyholders to get legitimate bills paid and could lead to fewer medical providers willing to treat PIP patients.

One outrageous provision in the proposed legislation would require medical providers and policyholders to submit to deposition-like questioning, examinations under oath, before claims will be paid. Another provision would allow an insurance company to deny a claim if there is a simple typographical error on a bill or in the policyholder’s medical records. And, the law would limit the amount of legal fees the insurance company would have to pay if it is determined to have wrongly denied a claim. How do any of these provisions stop PIP fraud? They don’t.

If the proposed legislation becomes law, many insurance companies will take advantage of loopholes that will be created in order to make it expensive, time-consuming and frustrating for medical providers to treat PIP patients. That is not fair to consumers. Legitimately fighting fraud must be the real target. Please do not fall for the insurance industry rhetoric.
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Cris Boyar is president of Floridians for Fair Insurance. FFI seeks to reform policies in Florida known as “bad faith” insurance laws and to protect Florida’s small-business owners and consumers from the threat of lawsuit abuse.

PIP fraud claims aren’t all they’re cracked up to be

From the Ft. Lauderdale Sun Sentinel

Uncategorized — posted by aaron deslatte on April, 7 2011 6:55 AM

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By Julie Patel, Sun Sentinel

Florida legislators are at work on laws, backed by major insurers and some consumer advocates, to combat what they say is “rampant” fraud by policyholders and health care providers filing PIP claims. The proposed legislation would, among other things, make it more difficult for people to file claims and for lawyers to collect huge fees.

Personal injury protection, or PIP, pays medical bills for policyholders injured in auto accidents, regardless of which driver is at fault. It’s intended to protect Floridians who don’t have health insurance and to avoid lawsuits and their costs for minor injuries. Florida drivers are required to carry $10,000 worth of coverage.

Lawmakers drafting legislation say there’s a “mountain of evidence” on PIP fraud, but most of the key data come from insurance industry groups, with some from the Department of Financial Service’s Division of Insurance Fraud.

Consider these points:

• The average payout for a personal injury protection claim increased over the past seven years — but not enough to keep up with the inflation rate for health care.
• The conviction rate for suspicious personal injury claims has dropped since mid-2007, even though the state beefed up its fight against fraud.
• Each Florida driver’s premiums were about $50 higher last year, the insurance industry says, to cover the cost of fraudulent claims, what insurers call the “fraud tax.”

 Keep reading.

Claims Of Personal Injury PIP Fraud Are Grossly Exaggerated

Brilliance in just a few words. As in all professions, those that commit fraud are an extreme minority.   They are the proverbial "squeaky  wheel" that gets the oil. That being said, the author of this article points out that PIP fraud accounts for less than 1% of all the insurance fraud relating to automobile accidents.  Yest companies like United Automobile & State Farm continue to pound the legislature with ridiculous claims that fraud is the industry standard rather than the exception to the rule. 

Let's not forget that with all the alleged growing fraud, State Farm still posted record profits of $800 Million in 2009 and $1.8 Billion in 2010.  Wow, who knew that fraud would increase their year to year profits so much ? I wonder how that happened. 

Anyway, here's a link to a fresh little article about the often hidden truths - Click here, read & enjoy