You hear it all the time from car insurance companies – Your premiums are so high because of fraudulent claims, and bad lawyers and doctors making money off the same. They say it on the news, they say it on TV, and they say it in Tallahassee, so it must be true, right?
Would you be surprised to know that true, actual auto insurance fraud occurs in about 0.6% of all auto insurance claims? You are reading that correctly, 0.6%, not even 1%; hardly a number to make significant legislative changes that take away your vested legal rights when you are injured in a car accident. Yet, every couple of years, we are told there is an “auto insurance crisis” and the Florida Legislature is called upon to make changes.
Well, let me share with you, from actual cases, why the “auto insurance crisis” is 100% manufactured and created solely by the industry.
Take the last week of my life. We had a garden-variety auto negligence claim that was set to go to trial in June. The court had a deadline for expert witnesses to be disclosed, over a month ago. Two Fridays ago, while finishing up my tasks for the week, I get an email with a late-filed expert report. So I open the report and begin reviewing the same. This insurance company, in the eleventh hour, on the eve of trial, disclosed what is known as a “coding” expert. That is someone who looks at the CPT coding on the bills of your doctor, that they submit for insurance reimbursement, and then comes up with a report that finds that your doctor did not pick the right code or should not have billed at all for the service rendered. In our case, this “expert” reviewed four months of physical therapy bills, and came to the conclusion that out of $13,000 in care, only $1,000 should have been charged.
My first question in reading this “expert’s” report, was to wonder if she had ever been to a hospital and received a bill for a $20 Tylenol? I asked that because, the insurance carrier did not have her look at all the medical providers, including a major local hospital. Instead, they told her to only look at the physical therapy center and the pain management clinic, where my client underwent several painful injections. If the insurance industry wants to put healthcare costs on trial, why not challenge all providers? Because clearly, the intent is to only harm those doctors who openly treat accident and injury victims. It is an intimidation tactic.
What is deeply disturbing to me about the use of this “expert” is that I uncovered evidence that she makes $250 doing nothing but reviewing bills for insurance companies and issuing similar reports. And she is not a licensed physician or health care practitioner. This is simply a hired gun, who goes in there and attempts to accuse doctors who treat car accident victims of insurance fraud, and nothing else.
What is even more disturbing, is that currently, a person like this “expert” is allowed to present this testimony. Even though it is founded on nothing but a purposeful intent to reduce the amount an at-fault insurance company has to pay, this lady can get on the stand and present these junk opinions. As a tax payer, you should be outraged. As a lawyer who has clients who have to wait years for their day in court, it outrages me to see valuable court time taken up by these shenanigans.
So, if you ever wonder why your insurance premiums are what they are, maybe our Legislature and lawmakers should take a closer look at how the insurance company uses the premium money they so easily collect. Is it fair that they pay thousands to “experts” who routinely and without compromise just deny anyone who is injured and receives legitimate medical care, and then, run to Tallahassee and say the “F” word (“fraud) every legislative session, and get favorable legislation passed? I don’t think so.
And here is the kicker, don’t think that taking them to Court is going to even it all out. It would have cost that client close to $10,000 to fight that “expert” alone, and at the end of the day, the value of the case would not have changed. There was no winning on our side and that is why this expert was injected into the case.
If this scenario angers you, like it does me, then remember it in the coming election cycle, and challenge every candidate on whether or not they think this is “fair.”
Everyone should get a fair chance at justice, nothing more, and nothing less.
Right now, as you can see, the deck is anything but even.
Michael T. Gibson is an Auto Accident Lawyer in Orlando. The law firm of Michael T. Gibson can help you obtain compensation for medical treatment, loss of wages, pain and suffering, etc. that you have incurred as a result of a car accident. Call 407-422-4529 or visit the website at www.autojusticeattorney.com.
