March 1, 2006 (Original publish date) • By Dennis Beaver
I was in an auto accident on our way to visit Lassen Park in Northern California. I admit this was not a major accident, and, frankly, I really felt fine at the time, but two days later saw an ad for a chiropractor that offered a free exam. We went camping after the accident, and I had no trouble hiking or rock climbing.
The damage to the car I was in was barely visible and no repairs will be made. My reason for writing you is that the chiropractor feels that I did sustain an injury and will need several months of treatment. He said auto insurance on the car I was in will pay all of his bills. He had me speak with a lawyer who felt I had a great case and he could guarantee me a nice settlement — several thousand dollars — even though I told them that, really, I felt fine and doubted if I needed treatment.
Both the chiropractor and the lawyer warned me that if I did not get treatment, I could suffer long-term significant back problems.
What do you recommend? My mom — who reads your column every week — tells me that I should get away from these people as soon as possible, but some friends from college say that I should get the treatment and let the lawyer handle the case, as it is a chance to collect some money I really do need for college expenses.
New concept to learn — It isn’t worth it
When this e-mail came in from a reader in Northern California, at first I wondered if it was a joke. Only it was no joke, as I learned when calling my reader. I phoned him back immediately, and got both him and his mom on the phone. “Mothers usually know best,” I said. “And this time, her advice will help you in ways you can’t even begin to imagine,” I said. My reader had a gut feeling that he was doing something wrong, and he was correct. It is called insurance fraud.
Typical victim
“Your reader is the typical victim/potential co-conspirator in auto insurance fraud cases. If he was in good enough shape to go rock climbing after the accident, and doubts that he’s hurt, then common sense should dictate his decision. Fear tactics, such as you’ll never be the same unless you get treatment now, is absolute nonsense,” I was told by Frank Scafidi, Director of Public Affairs at the National Insurance Crime Bureau (www.nicb.org), based in Palos Hills, Illinois.
“If you engage in any fraudulent activity, such as reporting injuries that did not occur, or helping others bill for unnecessary treatment for such non-existent injuries, you are, on the face of it, part of a conspiracy to commit insurance fraud,” Mr. Scafidi told me.
“California vigorously prosecutes these cases, and sends people to prison for up to 5 years in addition to huge fines. What your reader described is the typical case that generates thousands of dollars in unjustified and unneeded medical bills, chiropractic and physical therapy bills and attorney fees, and of course it’s paid by all of us who have auto insurance,” the former FBI Agent and now Spokesman for the NICB told me.
“Discovery of the fraud can easily have far reaching consequences — such as being dropped by your auto insurance company, or facing greatly increased premiums for both home and auto insurance. This industry maintains a data base of suspect claims, known as The Questionable Claims Data Base. When a suspicious claim comes in to an insurance company — picked up by an adjuster or medical payments staff — it will be reported to their Special Investigative Unit. You do not want your name on their list,” Mr. Scafidi stressed.
Long-term consequences
There are other, far-reaching consequences of making a suspect claim, even where fraud is not suspected. “For a college student, just getting started in the real world, you don’t want to damage your most important possession: Reputation,” the former FBI agent concluded.
In my general law practice, we have handled hundreds of personal injury cases over the past
25 years. While there are a lot of people who literally walk away from accidents and take Tylenol for a few days, preferring to get back to work and make no personal injury claim, there are just as many who think they have won The Big Spin. It is the Lottery mentality — I got in an accident, Great! Free Insurance money!
“That free money can come at a high cost,” a retired Farmers claims adjuster told me. “All insurance companies have an index of claimants — in most cases, just routine information, but in some cases, flagged for further study. If your name comes up too often, it is like the “boy who cried wolf.” Even legitimate claims may tend to be denied, as statistically, there is something that just does not make sense.”
The insurance industry knows more about us than we know about ourselves. Insurance is not intended as a way to make a quick buck. It is intended to guard against legitimate, unanticipated loss, to help us through tough times, to fix our car, pay our medical bills, fix our house or help replace the economic loss of a spouse or parent.
Lawyers or any health care professional who sees it otherwise deserve to lose their license to practice.
Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.