6/17 Protest To Stop Fraud By CA Insurance Commission Poizner's Fraud Assessment Commissio

http://www.californiaprogressreport.com/2008/03/why_hasnt_insur.html

Why Hasn’t Insurance Commissioner Steve Poizner Ever Prosecuted a Workers Compensation Insurance Carrier for Fraud?


By Ray Polly
Private Investigator
California Insurer Fraud Task Force

Why haven’t the Department of Insurance and District Attorneys around the state prosecuted a Workers Compensation insurance carrier for fraud? That’s a very good question that deserves an honest answer.

Simply put, there’s no money in it for them! California’s Workers Compensation insurance carriers fund the Fraud Assessment Commission’s fraud fighting war chest with surcharges on each and every insurance policy sold in California.

Our District Attorneys get money for successfully prosecuting you and I for fraud, but come on, prosecute an insurance carrier, the ones who commit wholesale fraud against injured workers; no way!

That certainly doesn’t make Insurance Commissioner Steve Poizner look very good. Mr. Poizner who publicly says he will prosecute any kind of fraud that is brought to his attention, privately simply looks the other way when prima facie cases of insurer and defense attorney fraud are brought to the attention of his legion of fraud investigators.

We have brought at least 2 cases to their attention, only to never hear from them again. And what about those medical legal doctors, many of whom are has-been washouts who use more of their creative writing skills than their medical skills? When they make a false statement to deny an injured Californian benefits under the law, does that not violate those same Insurance Code statutes too? Why haven’t we heard of any prosecutions or even investigations of them either?

Many of today’s cases of purported injured worker fraud are in actuality retaliatory prosecutions by the insurance carriers when they themselves are caught violating the laws. District attorneys from around the state, instead of performing independent investigations of these cases, simply take the information verbatim given to them from the Special Investigation Units (SIU’s) of the insurance companies and file criminal proceedings against innocent citizens in many cases literally ruining their lives. Police Officers and Police Dispatchers, County Employees and Assistant Principals are just a few of those innocent Californians who have been caught up in this web of greed!

Many of these innocent injured Californians are already at a great financial disadvantage having been forced to exist on substandard disability payments for long periods of time.

Many can’t afford private counsel and are forced to rely on Public Defenders who try to pressure and intimidate them to plead to lesser charges, not fully understanding that “No Contest” still means “Guilty” under the law.

And what’s worse, large self-insured employers are literally responsible to no one!

Concerned Californians are so up in arms at this fraud and corruption that they have banded together to form an Insurers Fraud Task Force here in California and I am stepping up to the plate on this one. I am a professional California Insurance Fraud Investigator and I was a California injured worker some 30 years ago. I am a principal of OnVideo Surveillance & Investigative Services of Sun City, California.

The California Insurer Fraud Task Force [CIFTF] was formed in response to the widespread abuses of the claims and benefit delivery processes within the California Workers’ Compensation system, as it exists today. Over the past twenty years, insurance companies have created a system in which the injured worker suffers horribly, while insurers are able to defraud the public and act with impunity, all in the name of their corporate profits!

Insurers have found and/or developed ways to circumvent the law and have intentionally bastardized and convoluted the very system designed to provide needed benefits and medical care to the injured workers of California and across the United States. The insurer’s creation and/or irresponsible use of Utilization Review, unqualified AME, IME, or QME Doctors, unethical defense attorneys, and private investigators/SIU, along with the improper application of the Exclusive Remedy has resulted in a plethora of fraudulent practices whereby insurers can literally steal from everyone; i.e., employers, injured workers, the general citizenry, and from State and Federal governments as well.

Insurance carriers claim that worker fraud is rampant, costing millions of dollars annually. It has been misrepresented as a widespread plague that needs to be eradicated; no statistical studies have been published to support their claim. This misconception and misrepresentation of the facts has resulted in the unjustified, unwarranted, and the illegal use of terror tactics employed to prosecute the injured worker for even filing a legitimate injury claim.

Working in conjunction with Californians Injured At Work, one of California’s oldest and largest injured worker advocacy organizations, CIFTF was created as an avenue for California’s injured workforce, their families, attorneys, doctors, and concerned citizens to provide and/or gather information. This information will demonstrate the business practices used, “in a usual and customary way,” by insurers to commit fraud and to act against public policy.

Moreover, the CIFTF was formed to act as an informational tool for Fraud Units within our state government; providing information for exposing the illegal activities of insurers and to be used in the prosecution of criminal insurance fraud committed by those insurance companies unwilling to comply with the law and/or to act in the best interests of the people of California.

Ray Polly is a private investigator licensed by the California Department of Consumer Affairs - Bureau of Security and Investigative Services with 30 years of experience. He has over 60,000 hours of surveillance and investigative experience related to Worker’s Compensation, Liability (BI/PI), and undercover investigations in the areas of Employee Theft, Loss Prevention, and Workplace Drug Abuse. He has assisted the California Department of Insurance, the Department of Justice, and the California Highway Patrol in the criminal prosecution of insurance fraud by individuals, organized gangs, and legal and medical professionals. Polly was recently featured in a Call Kurtis news feature on KOVR CBS 13 in Sacramento. For further information about the California Insurer Fraud Task Force, visit their website.

Posted on March 16, 2008
Comments

This is a very good question. Improper actions by insurers are not just limited to claims handling, either. Back in 2005, New York Attorney Spitzer, in his complaint against AIG, uncovered evidence that AIG had been systematically filing false reports with the California Department of Insurance, amongst other serious wrongdoing over premium charges. AIG settled the case without admitting wrongdoing. Now the NCCI is suing AIG for a billion dollars over similar issues, claiming that other member insurance companies were harmed to that extent by AIG's misdeeds over Workers Compensation insurance premiums. If that's how much other insurance companies were harmed, how much greater was the damage done to policyholders?