Our 2 cents on insurance company fraud

Michigan workers compensation lawyer discusses NICB report and provides a different perspective on “questionable claims.”

The National Insurance Crime Bureau (NICB) released its analysis of questionable workers compensation claims from January 1, 2011 through June 30, 2013. The report finds that while the total number of claims has been decreasing, the percentage deemed “questionable” has been rising.

NICB describes itself as the “preeminent” group fighting insurance fraud and crime. It is a not-for-profit organization supported by insurance companies and self-insurers. Questionable claims are self-reported by its members.

Top categories were claimant fraud, prior injury/not related to work, and malingering. Michigan was ranked 12th in the nation for 2013. We think the NICB report tells only half the story. Here is our perspective on questionable claims in Michigan.

Independent Medical Evaluations

Claimants are routinely sent to independent medical evaluations. These doctors are handpicked by insurance companies and are not truly independent. We see the same doctors over and over again because insurance companies know what to expect. Some doctors make a career out of testifying against claimants and earn hundreds of thousands per year.

Most of our clients get cut-off based upon an  IME. Common excuses include malingering and  pre-existing conditions. It is common for a person to be told that his or her condition is not work-related despite what the treating physician says. Sound familiar? We have seen individuals paid workers compensation for years and then suddenly benefits are stopped.

Using IME doctors to dispute valid claims is a type of corporate insurance fraud. Michigan needs rules to protect claimants from these bad doctors and unscrupulous insurance companies. IME doctors who receive more than 10% of their income from insurance companies should be disqualified based upon a conflict of interest.

Stop Insurance Company Fraud

Biased medical opinions must be challenged in court. All medical evidence, including treating physicians, should be considered. Don’t let the insurance company unfairly deny your workers compensation benefits.

Call (855) 221-2667 to speak with one of our Michigan workers compensation lawyers. We offer free telephone advice and never charge a fee unless you win.

Alex Berman is the founder of Michigan Workers Comp Lawyers. He’s been representing injured and disabled workers exclusively for more than 35 years.  Alex has helped countless people obtain workers compensation benefits and never charges a fee to evaluate a case.

Related information:

How insurance companies use IME doctors to abuse the workers comp system

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