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Archive for November, 2005

IIM Planning Fraud Summit

Friday, November 11th, 2005

October 24, 2005

The Insurance Institute of Michigan (IIM) and the National Insurance Crime Bureau (NICB) are sponsoring a statewide summit on insurance fraud in Lansing on Dec. 1, 2005.

The event will bring together representatives from the insurance industry, law enforcement, business and government to identify ways to counter the trend. The summit will also include information on property fraud, auto theft, arson, identity theft and medical fraud.

Michigan Attorney General Mike Cox will be on hand to discuss his role in insurance fraud prosecution. The Summit will also include information on property fraud, auto theft, arson, identity theft and medical fraud.

NICB is a not-for-profit organization that receives support from approximately 1,000 property/casualty insurance companies. The NICB partners with insurers and law enforcement agencies to facilitate the identification, detection and prosecution of insurance criminals.

IIM is a government affairs and public information association representing 40 property/casualty insurers and 50 related organizations operating in Michigan.

For more information about the Summit, contact IIM at 517-371-2880 or NICB at 708-237-4451

Insurance fraud up after storms in LA

Wednesday, November 9th, 2005

By BRETT TROXLER

btroxler@wbrz.com
2theadvocate.com staff
From a report by News 2\’s Scott Satchfield ssatchfield@wbrz.com

State authorities are busy tracking down insurance fraud suspects in the aftermath of Louisiana\’s recent hurricanes. The Louisiana Insurance Fraud Task Force is made up of the Attorney General\’s Office, the Insurance Department and State Police.

Officials say fraud reports are up, and the task force is sharpening its enforcement in response. State Insurance Commissioner Robert Wooley said fraud affects everyone in times like these.

\”Everybody is being vigilant right now because they don\’t want someone taking advantage of the system,\” Wooley said. \”Because it’s going to cost them down the line, and everybody understands that.\”

Those needing to report insurance fraud can call (866) 372-8305 or e-mail the task force at insurance.fraud.unit@dps.state.la.us. Insurance fraud can carry a penalty of up to five years in prison and mandatory restitution.

Book Release: Insult to Injury: Insurance, Fraud, and the Big Business of Bad Faith by Ray Bourhis

(CSRwire)

Ray Bourhis continues his strong commitment to justice by successfully taking on the insurance industry and criminal fraud in this compelling case study. He makes it clear that we need to do much more to end the shameful abuses of the current system and guarantee honorable insurance coverage for every American.
—Senator Edward M. Kennedy

Getting insurance companies to pay for individual claims is a problem so common it\’s endemic. And the very real fear that our health, disability, homeowners, and other insurance providers will not be there to pay for claims in the event of catastrophic loss is widespread and well justified. As San Francisco-based attorney Ray Bourhis found out, at least several giant disability insurers—including the largest disability carrier in the world, UnumProvident—made it company policy to cancel benefits in order to increase revenues by hundreds of millions of dollars. These claims were rejected and the policies cancelled regardless of their validity. And for a company with some 25 million-policy holders, the abrupt termination of disability benefits meant that thousands of lives and millions of dollars in benefits were placed at risk.

In the case of Joan Hangarter, a single mother who bought a disability policy in 1990 to protect her should she ever fall seriously ill, the cancellation of her policy led to personal devastation for both herself and her children.

Joan had dutifully paid her annual premiums for nearly a decade. Yet after she became disabled, her insurer UnumProvident, stopped paying her benefits. As a result, Joan and her children were evicted from her home, and Joan was forced into bankruptcy and onto welfare, leading her to fall and into deep clinical depression. All of this happened to Joan as a result a cost-cutting measure: employees of UnumProvident had targeted her for cancellation without ever having spoken with a single doctor who had actually treated her. Eventually, with the help of her attorneys Ray Bourhis and Alice Wolfson, Hangarter won a landmark $7.7 million jury verdict against UnumProvident.

In Insult to Injury: Insurance, Fraud, and the Big Business of Bad Faith Bourhis uses the dramatic story of Joan Hangarter\’s case—along with the cases of Susan McGregor, Stuart Gluck, Alan Gross, John Tedesco, Laura Hindiyeh, Eugene Molfino, and others—to show how insurance companies are getting away with denying valid claims, terminating benefits, and destroying lives. Bourhis shows how insurance companies put profit above the protection of those who diligently pay for their coverage month after month and year after year. Bourhis exposes the comprehensive systems insurance companies have for targeting and terminating expensive claims without just cause. He reveals the back-room strategic mindset that drives these illegal practices, how low-level employees are duped into unethical conduct, and how insurers manipulate data in the few cases that do go to trial. He also explains the key regulatory oversights that enable these kinds of practices to continue unchecked, and how recent U.S. Supreme Court decisions and the inaction of the current majority in Congress actually facilitate insurer fraud.

Hangarter\’s was not an isolated case, and her settlement, while welcome, was singularly rare. Unfortunately for us all, as Ray Bourhis points out, this single victory was not enough to change the way these companies do business. To change this system, Bourhis closes Insult to Injury with a roadmap for reforming the insurance industry, so that cases like Joan\’s become a thing of the past. He also makes the case against so-called \”tort reform,\” showing why it is actually a gift to the monied interests of large corporations and a threat to the legal rights of us all.

****

“What has happened to Joan Hangarter—and so many others like her—is a grave injustice…. Readers of this book should urge their congressional representatives to force the big insurance companies to honor their obligations just as the holders of those policies honor theirs.”
—John Garamendi, Insurance Commissioner, State of California

\”Painstakingly documented, hilarious, and insightful. A seething indictment of the out-of-control insurance industry and its friends in Congress and on the U.S. Supreme Court who have given it a green light to defraud Americans.\”
—Amy Bach, Executive Director, United Policyholders

****

Ray Bourhis is a partner with the law firm of Bourhis & Wolfson in San Francisco, California, specializing in insurance bad-faith litigation. A graduate of Boalt Hall at the University of California, Berkeley, Bourhis has been a court-appointed Special Master overseeing reforms in the California Department of Insurance and was appointed by U.S. Senator Barbara Boxer to her Federal Judicial Selection Advisory Committee. He was recently profiled by Ed Bradley in a 60 Minutes report concerning fraudulent insurance practices. Born and raised in Elmhurst, Queens, Bourhis credits an attempt by gang members to throw him into a blazing bonfire at the age of twelve with helping him develop the survival skills needed to deal with insurance companies. He lives in Kentfield, California.

****

Insult to Injury: Insurance, Fraud, and the Big Business of Bad Faith
By Ray Bourhis
Published by Berrett-Koehler Publishers, Inc.
ISBN: 978-1-57675-349-2
A BK Currents Book
Cloth, $24.95
Number of Pages: 262
Publication Date: September 1, 2005

NJ Anti-fraud agency faces questions

Friday, November 4th, 2005

Anti-fraud agency faces questions

Senator turns up pressure
Posted by the Asbury Park Press on 09/21/05
BY JONATHAN TAMARI
GANNETT STATE BUREAU

TRENTON, NEW JERSEY — The head of the state Senate Judiciary Committee is turning up the pressure on the state Office of the Attorney General as he reviews an audit that showed questionable billing by an agency meant to prevent insurance fraud.

In a recent letter, Sen. John H. Adler, D-Camden, said responses to his inquiry were evasive and devoid of credible foundations.

Adler, chairman of the judiciary committee, has demanded a second round of answers about the audit, which showed questionable billing by the Office of Insurance Fraud Prosecutor. The office serves under Attorney General Peter C. Harvey.

I\’m really distressed by some of their answers, Adler said in a telephone interview.

In a Sept. 13 letter, Adler asked for another set of answers by Friday. His next step, he said, will depend on the response.

We are currently . . . attempting to provide additional information to help further clarify answers to the senator\’s questions, said Paul Loriquet, a spokesman for Harvey.

Adler\’s questions focus on an audit released in July saying the Office of Insurance Fraud Prosecutor had charged insurance companies $1 million in \”questionable\” costs. Another $8 million in bills charged to insurers wasn\’t properly accounted for, according to the review by the Office of the State Auditor.

The Office of Insurance Fraud Prosecutor is meant to fight fraud, which is blamed as a major factor for high auto insurance rates. Insurance companies pay for the office, but the audit showed some of the charges from the prosecutor may not have been tied to fraud cases. Unnecessary charges billed to insurers may cause higher premiums.

After the audit was published, Adler wrote to Harvey\’s office with follow-up questions about how the fraud prosecutor was managed.

The auditor\’s report is not as benign as you seem to suggest, Adler wrote to Thomas J. O\’Reilly, an administrator for Harvey\’s Department of Law and Public Safety. The report reveals significant lapses in judgment and a reckless disregard of legitimate accounting controls.

Sen. Joseph M. Kyrillos Jr., R-Monmouth, another member of the judiciary committee, praised Adler\’s tone and demanded answers. He said it seems to be standard operating procedure in Harvey\’s office to begin reviews but never reach conclusions.

Jonathan Tamari: jtamari@gannett.com

Aug 20, 2005

JACKSON, Miss. – A grand jury in DeSoto County has indicted a state trooper on an insurance fraud charge.

Sgt. Charlie Hudson was indicted in a scheme to defraud an insurance company, according to a news release Friday from the Mississippi Department of Public Safety.

Highway Patrol spokeswoman Delores Lewis would not disclose the name of the insurance company or give other details. The investigation is continuing, Lewis said.

Agents with the Mississippi Bureau of Investigation arrested the 16-year officer Thursday night in Clarksdale without incident and transported him to the DeSoto County Jail.

An auto theft investigation by agents in Quitman County led to the discovery of evidence that implicated Hudson in the scheme, the release said.

Bond was set at $5,000. Hudson was released on his own recognizance. His initial court appearance is pending.

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