I happen to work in the industry that, that article is referring to. Insurance companies have been bilked billions of dollars in false health claims. Not to mention fighting fraud costs have sky rocketed. Insurance companies got a small reprieve after September 1st, 2010 with the new changes. There are some big time scammer clinics in Toronto and GTA. They submit false documentments, forge attendance records (saying the client attended when they didn't) and innondate adjusters with paperwork so we fall behind and things get "deemed" approved after a certain time line. So aside from paying clinics billions of dollars they don't deserve, we also have to spend money fighting fraud with pricey insurer examinations and paying investagators large sums of money to investagater suspicious activity.
Insurance companies were literally going broke paying out health claims and expensive (often not necessary) assessments. All the while YOU (the victim) is completely unaware this is going on in the backround. All because you happened to walked into the wrong clinic and signed some papers. I see it all the time where the client calls me fustrated (often ****** off) because they don't understand what's going on.
Is there a way to fight this? Not usually. Even if we prove outright they committed insurance fraud the claim often just gets closed and we never get our money back. Insurance companies like Economical have resort to suing in small claim courts to re-coup their money. However the clinics will just claim bankruptcy and open under a new name and a new manager. Then the cycle continues.
I've been handling accident injury claims for 5 years now and I have yet to see it get any better. I feel bad for the consumer caught in the cross fire. The way the legislation is worded it ties the adjusters hands to help people rightfully injured and needing help; and it opens the door for shady clinics and scammers to profit. Sorry about the rant but it pisses me off some days. All of our time is spent fighting fraud and stopping clinics from raping and pilligaging. Meanwhile; people who could use our attention and extra TLC get an all of 5 minutes of our actual attention.
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