August 25, 2012 (Original publish date) • By Dennis Beaver
Slowing down, about to stop for a red light, perhaps doing one or two miles an hour, Patricia’s 2007 Toyota Camary was rear-ended in December 2011, leaving “the rear bumper scratched and pushed in slightly,” her email to You and the Law stated.
“While the damage wasn’t all that visible — repair charges only $710 — my daughter and I did feel a ‘jolt’ and I noticed an odd tingling in my right arm along with very slight discomfort in my lower back. That is why we saw our chiropractor, just to be checked out. He immediately referred us to an attorney friend.”
Now, let’s fast forward to June of 2012. This incredibly minor auto accident has generated close to $60,000 in chiropractic, physical therapy, MRIs and expensive “pain management” M.D. treatment bills. It was simply an insurance scam, taking advantage of trusting patients.
“We had never been in anything like this before,” Patricia told us, “and now realize that the doctors and our lawyer were having us going through all of these procedures just to run up a huge bill. We feel so bad, because our lack of knowledge helped them!”
Of course, it’s bad enough realizing you have simply been a money-making tool for unethical health care professionals and the lawyer they work with. As you’ll see in a moment, what Patricia and her daughter didn’t know at the time was the damage this incident may yet cause them, years from now.
‘No concern for the patient’s best interest’
“This happens all over the country, and your reader fits the pattern of the perfect victim who is in an extremely minor auto accident with little or no property damage or injury,” states Frank Scafidi, spokesman for the Des Plaines, Ill.-based National Insurance Crime Bureau.
“We want the public to be aware of what an insurance scam looks like, how greedy people in the health care and legal professions find their victims, to realize this is a fight over money and not what is in the best interests of the patient/client. Also, it is so important to understand the risks faced personally by being associated with insurance fraud,” Scafidi states.
“It’s the auto accident with little or virtually no property damage and injury that invites fraudulent claims. You need to use common sense and good judgment, and listen to that little voice which tells you things are not right.”
Scafidi outlined some of the red flags:
1) You have a minor accident and are approached at the scene, or later contacted, and urged to see a certain doctor or lawyer. This is a huge red flag and the first step in what we refer to as “engineered fraud,” where you become a portal through which excessive and unnecessary treatment begins.
2) There is a well-established connection between property damage and bodily injury. If you are in a truly minor accident and basically feel fine and yet are being referred to specialists and scheduled for expensive tests and treatment, something is wrong.
3) If you are encouraged to continue treatment as a way to get a higher insurance settlement, this is trouble with a capital “T.” There is a distinction between a person who has been victimized and one who is part of the fraud. You could face prosecution if you are a knowing player.
4) We know real claimants get caught up in these things and do what they are told to do. If and when at some point things do not seem right, just out of self-protection, make an inquiry. Speak with your own insurance agent or claims adjuster.
Finally, if you think you may be the victim of insurance fraud, please call our hot line — 800-635-6422 or TEL-NICB. Also, look at our website: www.nicb.org.
Patricia now has a C.L.U.E.
Patricia and her daughter are facing long-term consequences from being involved in what is clearly insurance fraud, even though it would certainly appear they are innocent of any wrongdoing.
Their names are in a national database known as the Comprehensive Loss Underwriting Exchange. This is the 500-pound gorilla of personal information — claims history — used by insurance companies to “reduce risk and liability by assisting the underwriter in predicting future claims,” as its website states.
CLUE takes a seven-year look backwards at accident claims, with information submitted to it from insurance companies all over the country. On the condition that we not reveal her name, one fraud investigator for a major auto insurance company told You and the Law that someone in Patricia’s situation “will be looked at like ‘The Boy Who Cried Wolf.’
All it takes is one highly questionable claim for a later accident — even a real accident — to be seen in a very different light.”
Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.