Examples of Insurance Fraud
Self-funded Health and Pharmacy Insurance Plan Fraud
Sometimes third-party administrators and pharmacy benefit managers charge unauthorized fees to self-funded insurance health and pharmacy benefit plans. These extra fees may violate the contracts with the self-funded plan and a breach of fiduciary duty under the Employee Retirement Income Security Act (ERISA). Our insurance fraud attorneys are looking into these cases on behalf of self-funded plans.
Life Insurance Fraud
Beasley Allen’s insurance fraud lawyers have uncovered alleged fraudulent accounting practices by life insurance companies concerning premium increases. Fraudulent accounting methods may result in the policyholder being charged excessive insurance premiums.
A client who has a life insurance policy and has been notified of a substantial increase in premium payments, or who has been told their policy’s “cost of insurance” has increased, may have a valuable legal claim that our insurance fraud lawyers would like to investigate.
Rental Car Insurance Fraud
Our group of insurance fraud attorneys is working on class action claims concerning car rental agencies’ fraudulent representations in offering insurance coverage on rental cars.
If you have purchased rental car insurance with a major rental car company, you may have a valid legal claim that would merit class treatment.
Property Insurance Fraud
Insurance companies nationwide are unjustly depreciating labor costs on adjusted property claims (roof or fence damage, for example). The depreciation of labor costs is contrary to many insurance policy forms and leads to policyholders being under-compensated for their claims or not compensated at all, as depreciated labor costs may cause policyholders to fall short of meeting their deductible.
If you have made an insurance claim on your property in the past six years, our insurance fraud lawyers would like to review the adjuster’s estimate and your homeowner’s or manufactured home policy as you may have a case.
Denied Disability Insurance
Our insurance fraud attorneys are also reviewing cases involving the denial of individual and group disability insurance. These cases may involve employer-sponsored benefit plan policies (ERISA), individually owned policies, or non-ERISA governed supplemental insurance.
Many Americans have spent years faithfully paying for disability insurance. They rely on this insurance to cover them if they become disabled and unable to work. Nevertheless, many policyholders are stunned when their insurance provider refuses to pay their claim.
Unfortunately, some unscrupulous insurance companies deny legitimate claims from seriously ill or injured policyholders. Routine denial of disability insurance is an exploitative corporate strategy designed for one purpose – to boost corporate profits. It’s not uncommon that current and former employees insured through these fraudulent companies turn to the media and attorneys about this tragic situation.
Beasley Allen’s insurance fraud lawyers have found this occurs regularly to honest people who are simply looking to get out of their insurance policies what they were promised. When their claims are denied, they have nowhere to turn and no means to live.
Average Wholesale Price (AWP) / Medicaid Fraud
This body of litigation focuses on pharmaceutical companies that overcharge state Medicaid programs for prescription drugs. An examination of the pharmaceutical company price lists demonstrates the difference in the AWP and Wholesale Average Cost (WAC), which are the prices provided by the manufacturers for reimbursement and the actual price or cost of the drug. In some cases, the published AWP price was more than 2,500 percent higher than the actual price, and the WAC price nearly 600 percent higher.
Beasley Allen’s insurance fraud attorneys have recovered more than $1.5 billion in settlements and jury verdicts for the states we have represented in these claims. As a result, taxpayer dollars have been returned to the states and the agencies providing services to vulnerable residents. Our work in this area has completely changed how pharmaceutical manufacturers conduct business with states and their Medicaid agencies.
Also, supplemental insurance policies sold to Medicaid beneficiaries for hospital indemnity, cancer, disability, and other medical expenses are often rife with fraud. Most of these policies are virtually worthless to the medical recipient/policyholder. Some insurance companies have actually targeted lower-income consumers with these predatory insurance schemes.
What does ‘Bad Faith’ mean in insurance disputes?
Bad faith is simply a cause of action against an insurance company that has intentionally denied the payment of a properly submitted insurance claim for no debatable reason. Bad faith claims involve health and life insurance, accidental death insurance, disability insurance, automobile, property, and cancer insurance.
Beasley Allen’s insurance fraud lawyers have represented thousands of clients in bad faith actions and have had numerous verdicts in favor of our clients. We continue the tradition of representing clients who have been wrongfully denied benefits by their insurance companies.
We have pursued thousands of cases against the world’s largest insurance companies concerning disability policies, with specific attention to the “own occupation” disability policies. Our independent investigation of the insurance industry’s practices in evaluating and refusing to pay some of these claims is shocking. Further discovery has unveiled boardroom decisions to engage in a company’s schemes to wrongfully deny benefits to policyholders, all in the name of profit.
Racial Discrimination in the Insurance Industry
From the 1930s until the late 1970s, at least 30 insurance companies engaged in the shameful practice of charging “race-based insurance premiums” on so-called “burial policies” and/or “industrial life policies.”
This reprehensible practice involved unlawfully charging African Americans higher insurance premiums based solely on the color of their skin. Many companies engaging in race-based insurance schemes further compounded their wrongdoing by undertaking sophisticated measures to cover up their misdeeds.
Beasley Allen is involved in litigation against several insurance companies and their subsidiaries allegedly involved in race-based insurance fraud. We have previously settled more than 10,000 claims. The typical race-based insurance case involves an insurance policy sold before 1980 with a relatively low face value (usually under $5,000.00).
We continue to lead the nation in this area of the law for those persons who wish to “opt-out” of the class action lawsuits that often offer minimal benefits to certain policyholders compared to the potential recovery they may receive by filing their own lawsuit.
What is a ‘Death Spiral’ in Health Insurance?
For many years, Bealey Allen’s insurance fraud attorneys have defended the rights of policyholders who have been forced out of their health insurance coverage because of constant and exorbitant premium price hikes. As we continued to pursue discovery in these cases, we found that some health insurance providers engage in a practice known as “death spiraling.”
This practice involves a complicated process whereby companies move their unhealthy policyholders from their original risk group to another risk group with all or a greater number of unhealthy policyholders, thus justifying higher rate increases for higher risk. Insurers will continue to pull the healthy policyholders to another group, keeping them out of the “unhealthy group” in an effort for the company to “price out” and rid itself of the unhealthy policyholders. In this way, they ensure only healthy people who file small or few claims.
Death spiral schemes have left thousands of people nationwide without health insurance because they cannot afford the artificially inflated premiums. Our firm was one of the pioneers in this area of law, and we continue in that leadership role as we pursue these cases throughout the country.
Similar forms of fraud have occurred in the sale of nursing home policies, home health care policies, and long-term care policies for the elderly, but these policies employ more of a “bait and switch” method. Such policies are sold at “actuarially defective” prices (too low a premium to sustain the policy). Then the premium is “hiked” so high in the following months and years that the policyholder cannot afford it any longer.
Tragically, insurers engaging in this form of insurance fraud will “hike” the premium on an elderly person’s policy at a time when they need it the most. As a result, a large cash flow goes to the companies in the early years of the policies with the elimination of risk to the company later, when they price their loyal paying consumers out of the policies.
Sale of Annuities Fraud
Many insurance companies and national banks have joined forces to sell annuities to bank customers. Some of these annuity sales are based on fraudulent representations, inducing customers to purchase a product that will not perform as represented.
Beasley Allen’s insurance fraud lawyers have filed numerous class action lawsuits against national banks and major insurance companies for their combined fraudulent conduct in the sale of annuities. As a result of recent banking deregulation, banks are now allowed to sell insurance products to their customers. In some instances, banks have joined with insurance companies to underwrite these products. Subsequently, some of these insurance products are being sold based on blatant misrepresentation, especially concerning the explanation of how these insurance products perform.
Beasley Allen continues to be a leader in these class action cases throughout the country. “Helping those who need it most” is our mission, and we are dedicated to protecting consumers from these fraudulent insurance practices.
Contact an Insurance Dispute Attorney
Insurance fraud can be devastating to any policyholder. That’s because it usually hits people in a time of crisis, such as after a natural disaster, or it may affect investment security, result in consumers being overcharged, or result in policies they counted on being canceled, leaving them uninsured.
Experienced insurance fraud lawyers practice in our Consumer Fraud Section, handling claims related to many different types of insurance frauds. If you suspect any wrongdoing surrounding your insurance – car insurance fraud, health insurance scams, disability insurance frauds, or life insurance fraud, to name a few – we can help. We are available to talk about any suspected insurance scams at no cost or obligation to you.