Insurance Scams?

Residents of Grand Prairie, Arlington, Mansfield, Fort Worth, Dallas, Garland, Mesquite, Richardson, Carrollton, and other places in Dallas County and Texas should be concerned about insurance scams. They drive up the cost of insurance and nobody likes the thought of someone profiting from illegal actions. Most of the time when you think of this, what comes to mind is staged car wrecks, intentional fires to collect insurance money, and other similar actions. What you do not normally think of is, the insurance company being who is doing the scamming.
Here is a story worth reading.
The Houston Chronicle published an article on May 13, 2011, written by Patrick Danner. The title of the article is, “USAA sued anew over medical payouts in crashes Plaintiffs say insurer’s reviews are ‘shams’; firm defends pratices.”
This article tells us that USAA is again defending itself against charges it utilizes a “cost containment program” to improperly reduce or deny medical payouts to insurance customers injured in auto accidents.
The latest claims against the San Antonio financial and insurance company were made in a federal lawsuit filed the first week of May in the State of Oregon.
That lawsuit, seeks national class-action certification. It charges that USAA uses an outside auditor to assess claims and to “uniformly conclude that medical treatment was not needed” in claims that were submitted.
USAA, as expected denied the claims.
USAA has previously settled two class-action lawsuits that accused it of using flawed data to arbitrarily deny a portion of the medical benefits for injured custommers who have personal injury protection (PIP) or other medical payments coverage on their USAA auto insurance policies.
One of those cases, filed in Arizona, was settled last summer. Claims are still being processed, so the amount to be paid out under the settlement hasn’t been determined.
The other case, filed in Illinois was settled in 2005. Lawyers for the plaintiffs valued the settlement on their website at $35 million, a figure USAA spokesman Paul Berry called “probably wildly” inflated.
USAA settled the two case because it was the “right thing to do for our membership,” Berry said. He noted both courts endorsed USAA’s bill review practices.
“We pay all reasonable, necessary and accident related bills,” Berry said. “That doesn’t mean we pay all bills. If you had injuries or you received some treatment that had nothing to do with an auto accident, we’re not going to pay those bills.”
USAA relies on Alabama based Auto Injury Solutions to help review medical bills to determine whether they are reasonable and necessary and to weed out duplicative and fraudulent claims. Bills deemed suspicious are reviewed by a doctor or other health care professional, Berry said. Even when one of its doctors concludes the medical care wasn’t necessary, the bill still goes through several other reviews, he said.
USAA also can choose to override any instance where a bill is rejected, according to Berry.
In the latest Oregon lawsuit, four unrelated USAA customers in separate accidents allege the medical reviews were a “sham.”
USAA is not the only insurance company that does this. In fact a few companies, Allstate being one, uses a computer program to tell them whether or not they should pay a bill.
These are examples where the only way some people can get what they bargained for when they purchased the insurance policy is to seek the assistance of an experienced Insurance Law Attorney.