Abuse of no-fault law happens on both sides, hurts victims

No one plans to be in an auto accident. Victims are unwilling participants in a sudden and terrifying event that may change their lives forever. As Michigan auto accident victims attempt to learn about their legal rights, they must navigate through a maze of information – one that often makes it more difficult for them to recover injury benefits and move on with their lives.

Michigan’s auto no-fault law provides the most comprehensive medical coverage for accident injuries in America. Yet as quickly as they learn about their rights, victims may be confronted with an overwhelming amount of misinformation, questionable tactics, even criminal activity. This comes from a variety of bad actors.

One example is unscrupulous lawyers and medical professionals who attempt to directly solicit auto accident victims. These solicitations are typically to convince victims to become part of a scheme to pursue unnecessary medical treatment and work up frivolous lawsuits. Insiders call these “runner and capper” schemes. This phenomenon was recently reported in a recent Bridge story about no-fault abuse.

These types of schemes have no place in our society. The good news is that in 2013, the Michigan Legislature amended Michigan law to criminalize this conduct. It is now a crime for anyone to directly solicit an auto accident victim within 30 days after an accident. In addition, for the first 30 days after an accident, a person or organization is prohibited from using a police report for any direct solicitation. These are good reforms that were supported by the plaintiffs’ trial bar and consumer groups like the Coalition Protecting Auto No-Fault (CPAN).

Unfortunately, these reforms haven’t deterred all the bad actors. It is common for us to see in our practice clients who receive direct solicitations. These solicitations often come in the form a phone call from a person who won’t fully identify themselves. These shadowy people usually promise a quick settlement, ask the victim to sign paperwork, or suggest medical treatment from someone that the victim has never met. Consumers should be wary of this potentially criminal conduct.

But the bad actors are not only lawyers and medical professionals. They also exist in the insurance industry. Auto-accident victims are often confronted with overly aggressive insurance adjusters who look for virtually any reason to deny their claims. The tactics used by some insurance companies include conducting recorded interviews with the accident victim immediately following the accident. Unbeknownst to the victim, the adjuster is often seeking statements that the insurance company can later use to deny the victim’s claims for benefits.

And some adjusters will inaccurately explain the law or demand that the victim provide information that he or she is not actually required to provide.

Adjusters will also arrange for victims to undergo so-called independent medical examinations. Too often, these exams are done by doctors who, instead of treating patients, work primarily for insurance companies. In fact, recent lawsuits have uncovered that many of these doctors perform hundreds or sometimes thousands of insurance-company examinations each year. Not surprisingly, these doctors often disregard the recommendations of the victim’s medical providers and render conclusions that the adjuster uses to cut off further medical treatment. Unfortunately, the Michigan Legislature has done nothing over the past few decades to provide the people of Michigan with any further protection against this kind of insurance company conduct.

So auto-accident victims are not out of harm’s way following an accident. To protect their rights, victims must exercise their own due diligence and be cautious about whom they trust, whether lawyers or insurance companies. And while the Legislature considers changes to the Michigan auto no-fault law, it should consider reforms that protect people from all unscrupulous conduct – including that of insurance companies.

Bridge welcomes guest columns from a diverse range of people on issues relating to Michigan and its future. The views and assertions of these writers do not necessarily reflect those of Bridge or The Center for Michigan.

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Denise Copeland
Fri, 09/18/2015 - 5:58pm
Thank you Stephen and Thomas for touching on this subject. Having over a thirty year career in insurance, with the majority of that experience being in Workers' Compensation adjusting files in Los Angeles as well as supervision and management, I am quite familiar with every issue you have raised in your article, "Abuse of no fault Law happens on both sides, hurts victims". In addition to my above career, I married my husband near thirteen years ago who sustained a C5/C6 spinal cord injury and closed head injury during an altercation while he was a pedestrian in 1996. After moving back to Michigan and finding employment with General Motors as a workers' compensation adjuster and taking up a part time job in the evening, I met my husband in a semi-independent living facility. After about a month working a couple nights a week I started to learn about the injustices being made against him by the insurance company and those other entities being paid by the insurance company. It is easy for those involved to quickly get an idea of what the game is and how to support the person or company who pays your bills. Everyone from the home, to rehabilitation, to the medical management nurse understands that if they can demonize, that is to contribute data and information regarding the disabled claimant and usually the family, as being incapable of managing their own life or disability, the rewards are great for all involved. Imagine this, the insurance carrier can fight in court to secure both the guardianship and conservatorship of the disabled, by making both the disabled and their family in capable of managing the serious medical problems and care of themselves or the care by their family. Sometimes a little embellishment on the part of each medical entity in light of the real truth helps to start the ball in motion. The disabled did this or did not do this. The family did this or did not do this, causing this next problem to arise. And so on over a period of time, gathering evidence from everyone involved, with great documentation by the medical management nurse to prove the case for the insurance carrier to gain the ultimate goal of guardianship and conservatorship. Once they have these to legal documents of human ownership, managing the dollars on the case becomes a free-for-all! Everyone gets their due bonus for helping them build their case, that is a share of the money, but not without note that no one ever discussed such a plan. It is basically office politics at its best. I consider this one of the greatest fraudulent crimes of the insurance carriers and the parties who should be offering rehabilitation and medical care as partners in crime. Included in this line up of actors are the doctors and lawyers, sometimes knowing and sometimes not, and frequently trying their best to do what is right for all parties. If I excluded all from this crime I would be wrong or if I included all in this crime, I would be just as wrong. I will let everyone seek their own conscience. Now if the above plan doesn't work, the next avenue the insurance company takes after losing or settling out the original claim is to begin denying whatever they can get away with, as you know, no one over sees the fraudulent tactics of the carrier and their claims adjuster, always keeping in mind politics is played in the insurance office as well. The examiners learn quickly what the managers and VP's are happy about and what causes them concern. Rewards come in raises and promotions. The one that suffers the most is the injured and their family. I agree with everything both Stephen and Thomas has to share, I just wanted to add my two cents worth of experience both as a claims examiner and as the wife of a severely disabled No Fault claimant for an additional 18 years. Thank you for offering me the opportunity to express myself in this way. Denise
Sun, 09/20/2015 - 1:23pm
Been in an auto accident? First question is are you OK, But are you Realllly OK? Protect your benefits, call ******** spine and neck center now. Program our number into your phone, call us right after the police if you are in an accident. Nothing about quality of care, just a blatant pitch to let us screw you and your insurance company for injuries that may or may not be real, and reimbursements that are unlimited. And these ads are legal? Yes, we need no fault reform.
Mon, 09/21/2015 - 11:25pm
Excellent guest commentary by Stephen H. Sinas and Thomas G. Sinas. Importantly, it echoes the same points that Michigan Auto Law made in our comment to the original August 25, 2015, Bridge Magazine article by Nancy Derringer, “An accident runner, a chiropractor, and the push to curb no-fault insurance.” Specifically, Michigan Auto Law noted that “abuse and misuse of Michigan’s No Fault auto insurance system is not limited to just ‘insurance fraud network[s]’ such as those described in [Ms. Derringer’s] reporting. Auto insurers are guilty, too, of abusing and misusing the system. They pay hired-gun, insurance doctors to conduct so-called ‘independent medical examinations’ – or IMEs – whose primary purpose is to assemble ‘findings’ and ‘conclusions’ that the auto insurer can use to rationalize denying and/or cutting-off payment of an auto accident victim’s No Fault medical benefits. For instance, State Farm is known to have an IME policy whose goal is to save the auto insurer approximately $30 million per year (and, thus, boost profits by approximately $30 million). At least one frequently-used IME insurance-company doctor has been blasted by no less than a federal judge as being “disingenuous and misleading,” “very biased,” and “wholly lacking in credibility as well as reliability.” Additionally, another frequently-used IME insurance-company doctor has, among other things, fabricated and attributed imaginary medical conditions to a truck accident victim in order to justify a diagnosis that was “safe” for the defendant trucking company and that would save the insurance company money. But, as we noted in our previous comment, that’s not all. “Because there is no ‘authority’ to police auto insurers’ conduct and because Michigan has no “bad faith” law or punitive damages law and because Michigan’s Consumer Protection Act won’t protect auto insurance consumers against unscrupulous auto insurers, auto accident victims are vulnerable to other forms of abuse by Michigan auto insurance companies: (1) An auto insurer lying and fabricating its own rules for what an auto accident victim must show in order to collect No Fault wage loss benefits; (2) an auto insurer trying to trick auto accident victims by stubbornly and wrongfully continuing to use an ‘unenforceable’ venue provision in its UM/UIM (the same one that the Michigan Court of Appeals declared ‘unenforceable’ eight years ago in 2007; (3) an auto insurer trying to dupe an auto accident victim into forfeiting all present and future No Fault medical benefits by including ‘Full and final settlement of PIP claim’ on the victim’s No Fault wage loss check; (4) an auto insurer trying to avoid paying UM benefits by pursuing a legal strategy that was rejected by the Michigan Court of Appeals in 2014; and (5) an auto insurer making a low-ball settlement offer to an auto accident victim who did not have a lawyer, but, ultimately, settling the case for 3900% more once the auto accident victim retained a lawyer.” Again, we applaud Bridge Magazine’s tackling of the No Fault auto insurance fraud issue and we commend Mssrs. Sinas for their guest commentary. It is Michigan Auto Law’s sincere hope that the coverage of the No Fault issue and the issues raised both here in Bridge Magazine and elsewhere will inspire – and inform – lawmakers to consider auto insurance reforms that will preserve the important No Fault benefits that are vital to Michigan auto accident victims and will protect everyone – auto accident victims and auto insurance companies – from the harmful effects of No Fault fraud.