| Insult
to Injury is a lengthy and thorough special report by "The
Press Democrat" in Santa Rosa, California. They report that a 1995
study by the "insurance industry" found that insurers delayed
accepting 43% of permanent injury claims. "There are insurers
who as a matter of practice will contest virtually every claim,"
said James Ellenberger, assistant director of the AFL-CIO Department
of Occupational Safety and Health in Washington. "I've talked to
hundreds of people who say that this is not an unusual practice." |
| A
lobbyist for various insurance companies, Clayton Jackson, was convicted
of racketeering, conspiracy to commit mail fraud and money laundering,
and mail fraud. He was convicted of bribing then state senator Alan
Robbins who chaired the California Senate Insurance Committee. Jackson
offered Robbins a $250,000 bribe related to a pending workers' compensation
bill. He then solicited funds from insurance company executives
saying the money would be used to form a political action committee.
Jackson was later disbarred. |
| Denials
Made: Lawsuit Alleges Insurers "Hit List" was published
in the California Workers Comp Advisor. Some two-dozen insurance
companies are accused in a $200 million civil lawsuit of holding a clandestine
meeting that resulted in a "hit list" of medical companies
that the industry wants to drive out of business. The insurers deny
the allegations, which their lead attorney says amount to a "creative
pleading" designed to inflate a simple billing dispute that belong
in the workers' compensation legal system. |
| Allstate
superior's order agents to violate state laws on discrimination. A top-selling salesmen at Allstate blows the whistle and as a result,
Allstate is forced to pay what was then the largest insurance fine in
Texas history. The agent is stalked and chased by private eyes
for periods spanning six months, according to internal company documents
and Allstate takes away his business. |
| Paper
Chase Part I aired on NBC's Dateline June 23, 2000. In 15-month
investigation, they interviewed more than 250 people, reviewed more
than 70,000 pages of documents, and examined two companies that State
Farm did business with involving "independent medical reviews."
They state, "What we found was a disturbing pattern in the way
State Farm handled thousands of accident claims." [Link
2] |
| Paper Chase Part II was broadcast on July 25, 2000. The Dateline show added to the original
report (above) in significant ways. It stated that additional insurance
companies were using the same illegal and unethical tactics previously
highlighted. The show presented additional examples of fraud. The
transcript at the Web site is not the complete report that aired on
the TV broadcast though. |
| "Boeing
to Ill Workers: It's All In Your Head" is an investigation of Boeing.
The workers in this report suffered Multiple Chemical Sensitivity (MCS)
disorders. It's been a difficult struggle for workers to get workers
compensation carries and employers to recognize MCS illnesses as it
has been with Carpal Tunnel Syndrome. |
| RICO:
The U.S. Supreme Court. In a unanimous decision in January 1999
involving health care insurance payments, the Court held that the McCarran-Ferguson
Act does not protect insurance companies from liability under the Racketeer
Corrupt Organization Act (RICO). |
| The
Idaho Supreme Court upheld a decision by a jury in 1999 requiring State Farm Insurance to pay an Idaho woman $9.6 million after the
insurer allegedly used a biased medical review company to evaluate her
injury claim. The jury ruled that State Farm referred Cindy Robinson's
medical file to Medical Claims Review Service (MCRS), knowing that the
company would return a "favorable review" to State Farm and
give the insurer grounds to deny her claim. NBC's Dateline also questioned
State Farm's medical-claims handling practices in June 2000. State Farm
sells workers' compensation insurance. |
| Insurers
Seek to Uphold Agreements. Five companies that cut millions of dollars
in settlement deals with former state Insurance Commissioner Chuck Quackenbush
have filed court papers trying to prove the agreements are legally binding.
If the companies fail, they will face a fresh investigation into
allegations that they low-balled hundreds and possibly thousands of
people while paying damage claims linked to the 1994 Northridge
earthquake. |
| Seventeen
members of California's Department of Insurance Fraud Division filed
a whistleblowers' lawsuit against the insurance commissioner. They charged,
among other things, that DOI leadership conspired with insurance carriers
to ram fraud cases through the courts "without meaningful review." |
| Quackenbush
Under Fire... is a Los Angeles Times investigation that details
various acts by California's Insurance Commissioner. This includes political
contributions from insurance companies for the commissioner's wife's
who was running for the Senate. There was a $93,350 deposit into
a political bank account just nine days after Quakenbush proposed a
18.4% increase in workers' compensation rates. Millions of dollars
were involved in various activities. Quackenbush eventually resigned
but has not been prosecuted. Much more information on this can be found here. |
| Superior
National Insurance Group, one of California's largest workers'
compensation insurers, was seized by the California Insurance Commissioner.
It's downfall was "supposed" to be the result of fierce
competition and an adverse history of claims. Yet Superior was poorly
managed and made unwise growth decisions including the purchase of
Business Insurance Group, Inc. It
later sued the group for, among other things, FRAUD, negligent
misrepresentation, intentional interference with prospective economic
advantage, and VIOLATION OF BUSINESS & PROFESSIONS CODE §
17200. Kemper
Insurance later bought the insolvent company. |
| Public
Citizen published "Battle Over Anti-Worker Asbestos Liability
Relief Legislation Illustrates How Corporations Use Money, Influence
to Gain Special Favors. New Report Documents Conflict of Interest,
Huge New Lobbying Expenditures." |
| Anti-Fraud
Drive Proves Costly for Employees reports that the decade-old campaign
against workers' compensation fraud in California is part of a much
broader national effort to save money for employers and insurers at
the expense of workers. Among the legal scholars and researchers quoted
is Rand Corp. economist Robert Reville who says, "By making a claim
that there was a lot of fraud, I think they [insurance carriers] were
benefiting at workers' expense [and] discouraging workers from filing
claims." Under "Major Changes in the Law," Oregon's increased
legal standard to prove a workplace injury is briefly discussed. |
| Commercial Union ( CGU Group ) Consumers'
Forum is devoted to consumer rights, corporate governance
and ethics in the insurance industry. Advice for Insurance Claimants
required to submit to their insurance company's "INDEPENDENT MEDICAL
EXAMINATION. Click the above link if you have questions about an
IME exam. |
| ABC's
20/20 reported how Allstate Insurance Company, in settling claims
stemming from the 1994 earthquake in Los Angeles, "played hardball
with desperate homeowners, relying on questionable experts and falsified
reports, and defrauding policyholders of perhaps tens of millions of
dollars." |
| Two
HMOs Face Fines; Others Under Scrutiny State insurance and health-care
officials in Florida began looking into various practices of the managed-care
companies. Insurance Commissioner Bill Nelson issued a warning to the
state’s HMOs about not paying claims on time. In a bulletin, he
noted that insurance regulators had evidence of some HMOs denying certain
kinds of claims for no reason, a practice prohibited by state law. |
| Spying
Incident Leads to Charges Against Insurance Company is a press release
by Florida's Treasurer and Insurance Commissioner. He charges one of
the state's largest property insurers with attempting to "subvert,
manipulate and undermine" insurance regulators and has accused its
management with showing a "lack of trustworthiness" when it hired a
private investigator to spy on a Florida Department of Insurance employee. |
| Doctors
Admit Falsifying Insurance Claims details a recent study that suggests
doctors are increasingly using manipulation so that their patients can
receive the care they need. It states that more than 25% of the doctors
said they believed it is necessary to manipulate reimbursement rules
in order to provide high-quality care. We believe it's unfortunate that
this is occurring because insurance companies, HMO's, and MCO's put
profits ahead of patient's health. |
| "Protecting
your auto insurance settlement from your health care provider"
discusses how some hospitals are illegally laying claim to portions
of consumers' auto insurance liability settlements by billing both
the health insurer or HMO and consumer. |
| What
If the Company Won't Pay? by Kiplinger's Magazine talks about claim
denials and foot-dragging by insurers. This practice, quite profitable
for carriers in workers' comp claims, is now being utilized in other
types of claims. The article is lengthy and quite detailed in how consumers
can protect themselves. |
| Insurance
Horror Stories includes dozens of accounts of fraudulent activities
by insurance companies including Allstate. The main page of this
Web site is here. |
| Insurance
Company Bad Faith contains information on how to fight insurance
companies who harm you. They also list court judgments against insurance
companies such as Travelers, State Farm, Essex, and Aetna. |
| Farmers
Insurance News-Alert updates consumers with publicly available information
concerning the Farmers Insurance Group. This includes news reports,
consumer complaints, lawsuits, multi-million dollar court decisions,
and other legal actions. |
