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Mark Bello
Mark Bello
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Allstate vs. NY PIP Providers: The Pot Calls the Kettle Black

2 comments

Allstate Insurance Company is ramping up its campaign to recoup money it claims that it paid out in fraudulent NY no-fault medical claims. I am not close enough to this situation to judge the case on its merits. Several of the defendants are under federal indictment (at least, that's what Allstate says). Was there fraud? Maybe, maybe not. That is not the point of this post.

I do have considerable experience in dealing with Allstate on no-fault claims in the only state in the union that provides unlimited medical (PIP) coverage under its automobile no-fault statute. That state is Michigan and Allstate's claims-handling policies are, in a word, despicable. After identifying a victim (usually upon receipt of the form that begins the claim, an "Application for Benefits"), Allstate immediately jumps into the claim. They want to offer sympathies, right? They want to tell the clients that they are "in good hands", right? They want to tell them not to worry, they have unlimited medical coverage and they can treat with their specialist until the specialist pronounces them healed, right? Wrong!

The "Good hands" people may say all of these things, but actions speak louder than words; the company has an unlimited number of doctors at its disposal all of whom receive millions per year from Allstate and other insurance companies to perform what the company calls an "independent" medical exam. The use of the term "independent" is merely the first of many lies, so much so that plaintiffs' attorneys in the state have successfully challenged the insurance industry's use of that term in requiring and performing these exams. They are now, appropriately, called "defense medical exams". The purpose of these exams? To provide an opinion contrary to that of the treating physician; to say that the plaintiff is fine, even when he/she isn't; to cause the termination of benefits and force the patient to hire an attorney. A long, legal battle ensues and the plaintiff must find a doctor who will treat on lien and wait for his/her money or go for the length of the litigation without treatment. Then, this ***%%##** insurance company will, with a straight face, argue that the plaintiff must be fine because he/she went three to five years without treatment!

So, excuse me, but I take this "attack on fraud" litigation with a grain of salt. This is a company that has been taking premiums from and wrongfully denying benefits to its policy holders for years. In my humble opinion, it is "fraud" to retain a doctor with a predisposition and a financial incentive to deny claims. For a company that engages in this conduct to whine about and file suit against practitioners who treat plaintiffs is hypocritical. It also smacks of intimidation; what doctor will render treatment to an injury victim in NY if he/she knows that it will take years to receive compensation, if at all, and the possibility exists that companies like Allstate will sue in an attempt to take his/her license. And this is one of those companies which, in concert with the US Chamber of Commerce and its legal reform storm troopers, lobbies for tort reform by claiming "lawsuit abuse". "Lawsuit abuse" indeed! By which side, Allstate?

My friends: There are two sides to "lawsuit abuse" and abuses are most serious on the defense side of a personal injury case. Insurance companies have what the American Association for Justice calls the "delay, deny, confuse and refuse" tactic down to a science. My industry, the lawsuit funding industry, was born out of plaintiff and plaintiff attorney frustration and financial ruin caused by these tactics. Allstate's own dastardly claims behavior is so abhorrent that it became the subject of a terrific book. As the country continues to turn away from its core values and embraces the rhetoric of political hacks like Rush Limbaugh, take a moment and think about your future. What if you were in a serious automobile accident that wasn't your fault? What if your injuries cost you your life, your limbs, disabled you for life? How would you support yourself? How would you want your insurance company or the insurance company of the perpetrator to treat you? How would you feel if the company you paid premiums to for years, with no claims filed, began calling you and your doctor crooks at the filing of your first claim?

Is there fraud in New York on the plaintiff side? I don't know; I will let the lawsuit play itself out. I can virtually guarantee that there are shady practices and despicable conduct being engaged in by insurance companies in NY, on the defense side, every single day, and, somehow, this fraud never gets prosecuted. You cannot interest a prosecutor in pursuing this type of corporate fraud and intimidation. So forgive me, dear readers, there will be no pity party for Allstate in the Bello house.

Mark M. Bello is the owner and founder of Lawsuit Financial Corporation where he is instrumental in providing cash flow solutions and consulting when necessity of life lawsuit funding is needed during litigation. Mr. Bello has thirty-four years experience as a trial lawyer and 13 years as an underwriter and situational analyst in the litigation funding industry. He is recognized as an expert in this field by ExpertPages.com and ALM Experts. Mr. Bello is a sustaining and Justice PAC member of the Michigan Trial Lawyers Association, Justice Pac member of the American Association for Justice, Member of the American and Michigan Bar Associations, Member of Public Justice and Public Citizen, Member of InjuryBoard, out-of-state member of the Mississippi Association for Justice and a business associate of the Florida Justice Association, Texas Trial Lawyers Association and the Consumer Attorneys of California. His articles have appeared in FindLaw, The West Reporter, The Safety Report, Plaintiff Magazine, Advocate Magazine, and other fine legal publications.

2 Comments

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  1. Jim Miactkowsky says:
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    Another ambulance chaser playing the “shell game” The fact of the matter is the defendants in the Allstate lawsuit have ALL been arrested by the FBI and charged with Health Care Fraud, which if convicted, carries a prison term of 20 years.

    The lawsuit that Mr. Bello references has nothing to do with the lax oversight of bogus medical facilities and crooked attorneys in a state 500 miles away, which Mr. Bello needs to defend to put money in his own pocket.

  2. Mark Bello says:
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    Mr. Miactkowsky: I indicated that I would let the litigation speak for itself. I made clear in the post that I am not defending fraudulent conduct. I do not defend crooked attorneys nor do I need to defend them to put “money in my pocket”. These charges and arrests result from Allstate’s own efforts, which renders them suspect. While arrests and charges are not evidence of guilt and people are, in this country, innocent until PROVEN guilty, he behavior of those being pursued and/or indicted in NY was not the point of the post. If you bother to actually read the post, and can get by your obvious, anti-attorney, bias, you will see that it refers to the FACT that fraud cuts both ways. It is, in my opinion, FRAUD to purchase negative medical opinions for the sole purpose of denying necessary benefits to your own, premium paying, seriously injured, policy holders. THAT is what the post is about. Allstate behaves badly all over the country; how it behaves in Michigan is consistent with how it behaves in New York and elsewhere. Don’t believe me? Ask lawyers in any state on EITHER side of any case. That my state is “500 miles away” does not alter the fact that Allstate is one of the biggest abusers of the AMERICAN civil justice system; as such, it lacks credibility to accuse ANYONE of wrongdoing. Instead, if its top brass wishes to identify and weed out “criminals”, they need only find the nearest mirror. Next time, READ before commenting.