Here in Florida, a House subcommittee this morning approved a controversial bill that would limit fees for attorneys who sue insurance companies in disputes about so-called PIP claims...and here we go again.
Insurance companies cry foul when it comes to fraud because they say they are losing so much money due to fraudulent claims. This year not only were they promoting their agenda regarding PIP fraud and staged accidents, but suddenly sink holes too.
Please realize that an insurance company is a business like any other. So they try to wield their political influence in such a manor as to gain any business advantage in their market. Remember, they are in business to make a profit. And, there's nothing wrong with that. But when you run a company like State Farm and constantly tell people you're losing money to fraud when in 2009 you made a paltry $800,000,000.00 profit (yes, that's 800 million) and then in 2010 you increase your profits to $1,800,000,000.00 profit (that's 1.8 Billion in profit)...yet you continue to cry to your legislatures that fraud is continuing to harm your business, who do you think you're fooling?
No doubt that fraud should be stopped for no other reason than it's fraud and it's wrong. But if the stated statistics are true, then it seem that with the increase in fraud comes an increase in insurance company profits. I'm not sure how that works, but it seems to be the case.
But with all of the efforts that have taken place, one of the biggest reasons for a change in legislation is because fraud costs the consumers just way too much money...AND it's taking money out of the consumer's pockets. Yet, with all the legislation, with all the hoopla, with all the incredible profits posted by these insurance companies, I have yet to see one of them lower their premiums. None!
When do the consumers get to save money? How much does someone like State Farm or the others have to profit by to get them to stop raising rates? Maybe $1.9 Billion and we get a discount? Excuse me but I won't hold my breath.
The real fraud is that this is a game to the insurance companies. They cry fraud, they get their PR companies to get article after article in the newspapers and stories on TV all to justify their raising your rates... Good luck to them, let's see if you can make a $2-Billion Dollar profit in 2011.
Seems like in a down economy, being an insurance company would have been the best bet. People pay you for insurance and you get to deny their claims until an attorney calls you on it. Now, they want to limit an attorney's ability to protect the rights of citizens. Assuring their ability to increase their profits and rake you over the coals on their way to the bank to deposit their profits.
http://www.healthnewsflorida.org/top_story/read/state_officials_target_fraud_tax
Wednesday, March 16, 2011
Wednesday, March 2, 2011
State Farm Profits Double in 2010; Yet Says Losing Money Due To Fraud
Each year insurance companies for whatever section of the insurance market cry foul when it comes to fraud. They wine & dine our legislators, contribute large amounts of money to their re-election campaigns, give donations to they favorite charities all to get them to introduce legislation to curtail "fraud". Yet, time and time again, it seems as if the insurance companies continue to win big with their profits.
According to ChicagoBusiness.com, & The Chicago Tribune; State Farm has doubled its profits last year. They hide these facts yet throw up smoke screens of fraud and every turn. Why? Because it enables them to justify raising your rates for insurance. For details, click here to read the full story.
Just remember, there's a difference between losing money and not making as much profit. And as we now see, in spite of alleged fraud claims, State Farm (and I'm sure others) are profiting nicely. Especially in an economic environment where half of their policy holders are probably having difficulty paying their premiums, holding a job and keeping a roof over their families head.
I hope someone in the state legislature sees this before trying to introduce more crazy legislation to stem insurance fraud that is but a minor blip on the screen. You see last year, State Farm only made $800 million profit. This year, State Farm made $1.8 BILLION in profit.
You think now maybe you can pay my doctor and fix that dent in my car?
According to ChicagoBusiness.com, & The Chicago Tribune; State Farm has doubled its profits last year. They hide these facts yet throw up smoke screens of fraud and every turn. Why? Because it enables them to justify raising your rates for insurance. For details, click here to read the full story.
Just remember, there's a difference between losing money and not making as much profit. And as we now see, in spite of alleged fraud claims, State Farm (and I'm sure others) are profiting nicely. Especially in an economic environment where half of their policy holders are probably having difficulty paying their premiums, holding a job and keeping a roof over their families head.
I hope someone in the state legislature sees this before trying to introduce more crazy legislation to stem insurance fraud that is but a minor blip on the screen. You see last year, State Farm only made $800 million profit. This year, State Farm made $1.8 BILLION in profit.
You think now maybe you can pay my doctor and fix that dent in my car?
Thursday, November 4, 2010
United Automobile Insurance Company Tactics Get The Boot By The Supreme Court of Florida & Set New Legal Precident
No longer can an insurance company use a "No-Show" at an IME as the basis to deny a claim. Since EUO's are not part of the PIP statute, one can argue that a "No-Show" at an EUO also cannot be used as the basis to deny a claim.
The decision is still hot off the presses as it came down earlier today. To see all the details click on this link Cluster Medical Center a/a/o Maximo Masis v United Automobile Insurance Company
Friday, October 1, 2010
Insurance Adjusters & Appraisers Committing Insurance Fraud in Miami.
5 Insurance adjusters and appraisers commit fraud by taking kickbacks and payoffs.
If you've ever wondered why your insurance rates keep going up, read this and you'll begin to understand the story.
Read: Insurance adjusters commit fraud
If the link doesn't work, copy and paste this into your browser: http://www.sun-sentinel.com/news/local/florida/fl-adjusters-appraisers-charged-20101001,0,6297211.story
And I'm sure if the arresting investigators poked around more, they'd find bigger fish at the top...
FLPIBlog
If you've ever wondered why your insurance rates keep going up, read this and you'll begin to understand the story.
Read: Insurance adjusters commit fraud
If the link doesn't work, copy and paste this into your browser: http://www.sun-sentinel.com/news/local/florida/fl-adjusters-appraisers-charged-20101001,0,6297211.story
And I'm sure if the arresting investigators poked around more, they'd find bigger fish at the top...
FLPIBlog
Wednesday, July 7, 2010
United Automoble Insurance Group & Others Only Telling Half The Story - Is There Another Side To Fraud?
Please do not fall prey to recent insurance industry propaganda. Insurance companies, like United Automobile Insurance Company, are planting stories about fraud that bear no relationship to reality. The public should realize the insurance industry has embarked on a strategic campaign designed specifically to poison the pool of potential jurors while at the same time filling its bloated coffers with premiums Florida citizens are legislatively mandated to pay. Insurance companies, like United Automobile Insurance Company, use business models that require their insureds to attend compulsory medical examinations (CMEs), also known as Insurance Medical Examinations (IMEs), and Examinations Under Oath (EUO) at alarming rates.
An examination under oath is where the insurance company demands the insured go to the office of the insurance company to answer questions about a claim. A compulsory medical examination (CME) is where the insured is compelled to be physically examined by a doctor selected by the insurance company. A CME is supposed to be used by insurance companies to determine if future care is needed. Under Florida law, an insurance company can only cut off care if the insurance company obtains a report from a doctor stating no further care is medically necessary. These insurance doctors are supposed to be independent, fair and neutral.
In reality, insurance companies will immediately schedule these examinations, even before the insurer receives a single bill. Insurance companies know that a certain percentage of people will not attend these examinations if requested. This “no show” results in a basis for the insurance company to deny care. Additionally, many of the doctors used by the insurance companies are far from independent, fair and neutral. Typically, these doctors generate reports stating no more care is needed in the vast majority of times the doctor examines the patient at the request of an insurance company. Many of these doctors earn the majority of their income by working for the insurance companies. These doctors know that the insurance companies want the patient to be cut off. This saves the insurance company money. Alternatively, the insurance companies use doctors to do paper reviews of the medical records and opine that the only care that is reasonable will fall under the patient’s deductible. This means the insurance company would not have to make a payment. Accepting premiums and denying claims is a very profitable business model.
For some reason, the stories posted by the insurance industry, including United Automobile Insurance Company, fail to inform the public of this practice of scheduling compulsory medical examinations knowing a percentage of insureds will not appear so that the “no show” can be a basis to deny care as well as the practice of using doctors to cut off care the vast majority of time. It true there is a small percentage of fraudulent claims. However, it is just as true that insurance companies fail to act in their insured’s best interest, as opposed to protecting their own greedy profit motives. For this reason, virtually every jury trial results in a verdict for the patient or the doctor and against the insurance company. Jurors are smart and have more common sense than the insurance companies give them credit for having.
Thursday, March 18, 2010
Insurer Targeted HIV Patients to Drop Coverage
Does Anyone Remember The Movie "The Rainmaker"?? Read on...
Murray Waas
WASHINGTON
Wed Mar 17, 2010 1:40pm EDT
WASHINGTON (Reuters) - In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.
U.S. | Health | Healthcare Reform
Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.
So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.
But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.
In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy.
In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.
By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.
Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
The revelations come at a time when President Barack Obama, in his frantic push to rescue the administration's health care plan, has stepped up his criticism of insurers. The U.S. House of Representatives is expected to vote later this week on an overhaul of the health system, which Obama has said is essential to do away with controversial and unpopular industry practices.
Insurance companies have long engaged in the practice of "rescission," whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses. But government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.
In his previously undisclosed court ruling, the judge in the Mitchell case also criticized what he said were the company's efforts to cover its tracks.
Assurant Health said that as a matter of policy it did not comment on individual customer claims.
"We disagree with certain of the court's characterizations of Assurant Health's policies and procedures in the Mitchell case," it said in a statement provided by spokesman Peter Duckler, adding: "The case continues to progress through the appellate process."
"REPREHENSIBLE" CONDUCT
Much of the trial record of the Mitchell case is bound by a confidentiality order and not available to the public. But two orders written by the presiding judge, Michael G. Nettles, a state circuit judge for the 12th Judicial District of South Carolina, of Florence County, describe the case in detail. Judge Nettles wrote the orders in response to motions by Assurant that the jury's verdict be set aside or reduced.
In the motions, Nettles not only strongly denied Fortis' claims but condemned the corporation's conduct.
"There was evidence that Fortis' general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy," Nettles wrote.
Elsewhere in his order, Nettles noted that there were no "minutes of actions, votes, or any business conducted during the rescission committee's meeting."
The South Carolina Supreme Court, in upholding the jury's verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court's finding that Fortis destroyed records to hide the corporation's misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."
In affirming the trial verdict and Nettles' order, Toal was as harsh in her criticism of the company as Judge Nettles had been. "We find ample support in the record that Fortis' conduct was reprehensible," she wrote. "Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."
Fortis canceled Mitchell's health insurance based on a single erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy. When the company's investigators discovered the note, they ceased further review of Mitchell's records for evidence to the contrary, including the records containing the doctor's diagnosis.
Nettles also suggested that Fortis should have realized the date in the note was incorrect: "Not only did Fortis choose to rely on one false and unreliable snippet of information containing an erroneous date to the exclusion of other information which would have revealed that date to be erroneous, Fortis refused to conduct any further investigation even after it was on notice the evidence which aroused its suspicion to be false," the judge noted.
Fortis "gambled" with Mitchell's life, Nettles wrote.
Their motive, according to the judge, was obvious: "The court finds that Fortis wrongfully elevated its concerns for maximizing profits over the rights and interest of its customer." In upholding Nettles' verdict, the South Carolina Supreme Court similarly ruled that "Fortis was motivated to avoid the losses it would undoubtedly incur in supporting Mitchell's costly medical condition."
While declining to comment on specific cases, Assurant said in the statement: "All insurance companies have processes to review claims to ensure their accuracy, completeness and compliance with policy provisions and we evaluate all claims on an individual basis."
Click here to read the full/original article
Murray WaasWASHINGTON
Wed Mar 17, 2010 1:40pm EDT
WASHINGTON (Reuters) - In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.
U.S. | Health | Healthcare Reform
Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.
So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.
But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.
In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy.
In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.
By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.
Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
The revelations come at a time when President Barack Obama, in his frantic push to rescue the administration's health care plan, has stepped up his criticism of insurers. The U.S. House of Representatives is expected to vote later this week on an overhaul of the health system, which Obama has said is essential to do away with controversial and unpopular industry practices.
Insurance companies have long engaged in the practice of "rescission," whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses. But government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.
In his previously undisclosed court ruling, the judge in the Mitchell case also criticized what he said were the company's efforts to cover its tracks.
Assurant Health said that as a matter of policy it did not comment on individual customer claims.
"We disagree with certain of the court's characterizations of Assurant Health's policies and procedures in the Mitchell case," it said in a statement provided by spokesman Peter Duckler, adding: "The case continues to progress through the appellate process."
"REPREHENSIBLE" CONDUCT
Much of the trial record of the Mitchell case is bound by a confidentiality order and not available to the public. But two orders written by the presiding judge, Michael G. Nettles, a state circuit judge for the 12th Judicial District of South Carolina, of Florence County, describe the case in detail. Judge Nettles wrote the orders in response to motions by Assurant that the jury's verdict be set aside or reduced.
In the motions, Nettles not only strongly denied Fortis' claims but condemned the corporation's conduct.
"There was evidence that Fortis' general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy," Nettles wrote.
Elsewhere in his order, Nettles noted that there were no "minutes of actions, votes, or any business conducted during the rescission committee's meeting."
The South Carolina Supreme Court, in upholding the jury's verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court's finding that Fortis destroyed records to hide the corporation's misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."
In affirming the trial verdict and Nettles' order, Toal was as harsh in her criticism of the company as Judge Nettles had been. "We find ample support in the record that Fortis' conduct was reprehensible," she wrote. "Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."
Fortis canceled Mitchell's health insurance based on a single erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy. When the company's investigators discovered the note, they ceased further review of Mitchell's records for evidence to the contrary, including the records containing the doctor's diagnosis.
Nettles also suggested that Fortis should have realized the date in the note was incorrect: "Not only did Fortis choose to rely on one false and unreliable snippet of information containing an erroneous date to the exclusion of other information which would have revealed that date to be erroneous, Fortis refused to conduct any further investigation even after it was on notice the evidence which aroused its suspicion to be false," the judge noted.
Fortis "gambled" with Mitchell's life, Nettles wrote.
Their motive, according to the judge, was obvious: "The court finds that Fortis wrongfully elevated its concerns for maximizing profits over the rights and interest of its customer." In upholding Nettles' verdict, the South Carolina Supreme Court similarly ruled that "Fortis was motivated to avoid the losses it would undoubtedly incur in supporting Mitchell's costly medical condition."
While declining to comment on specific cases, Assurant said in the statement: "All insurance companies have processes to review claims to ensure their accuracy, completeness and compliance with policy provisions and we evaluate all claims on an individual basis."
Click here to read the full/original article
Sunday, February 14, 2010
United Automobile Insurance Company Fighting Fraud??? Are You Kidding Me???
How is it that an insurer that has been caught denying most claims without any justification is now fighting fraud? This is like the fox guarding the hen house. Many doctor refuse to treat those insured by United because United Auto blindly denies so many claims (Go dig through your DVD library and re-watch the movie: The Rainmaker with Matt Damon and you'll understand what we're talking about). For no good cause, United Auto forces their insured to go to “their doctors” to be examined. Their "I.M.E." doctors almost always say care is not needed. Don't your find it funny that people get into car accidents and are ALMOST ALWAYS are deemed to be 'okay' and their benefits cut off. Tell me that’s not fraud...
United Auto forces most of their insured to go to the home office of United Auto to give a recorded statement simply for making a claim. UAIG does this because when an insured does not go to their doctor or to their statement, United Auto can use this "failure to attend" as a basis to deny their claim and deny their insurance benefits. United Auto is great at taking money from the hard working insured people of Florida, but they have not figured out how to pay claims without putting up hurdle after hurdle to deny claims......
For those that they (UAIG and others) legitimately catch perpetrating fraud - well, kudos to them. But we'll reserve the kudos for UIAG and others, and give them out on a case by case basis. Although there's the appearance of fighting fraud on the surface, it's all about not paying out benefits as the foundation of their efforts. For some not to strange reason, we're still thinking about that fox and the hen house thing. That being said, the stance of the Florida Personal Injury Blog is that all fraud should be stamped out. We'd like to see those with real injuries have their rights protected under the law and the terms of their insurance contracts; and their injuries treated until they are back to "normal" or at least until they've reached maximum medical improvement - with only necessary treatments and diagnostic tests done.
Post your comments & stories below
United Auto forces most of their insured to go to the home office of United Auto to give a recorded statement simply for making a claim. UAIG does this because when an insured does not go to their doctor or to their statement, United Auto can use this "failure to attend" as a basis to deny their claim and deny their insurance benefits. United Auto is great at taking money from the hard working insured people of Florida, but they have not figured out how to pay claims without putting up hurdle after hurdle to deny claims......
For those that they (UAIG and others) legitimately catch perpetrating fraud - well, kudos to them. But we'll reserve the kudos for UIAG and others, and give them out on a case by case basis. Although there's the appearance of fighting fraud on the surface, it's all about not paying out benefits as the foundation of their efforts. For some not to strange reason, we're still thinking about that fox and the hen house thing. That being said, the stance of the Florida Personal Injury Blog is that all fraud should be stamped out. We'd like to see those with real injuries have their rights protected under the law and the terms of their insurance contracts; and their injuries treated until they are back to "normal" or at least until they've reached maximum medical improvement - with only necessary treatments and diagnostic tests done.
Post your comments & stories below
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