Insurance fraud

[heironymouspasparagus]

Classic cases of insurance fraud.  Just gotta love Okrahoma!

Case 1.  Injured at work.  Fought the workers comp claim all the way.  Company fired the person after two months off injury, since they filed a claim.  Even though previous performance reviews were glowing.  Finally court, with real doctors (3 of them) instead of the insurance hack.  Ordered to pay for surgery and therapy.
AIG Insurance.  No big surprise there.   Looking out for the customer every step of the way...


Case 2.  Injured at home.  No workers comp involved, but surgery and 8 weeks off work.  Company supplied long term disability insurance fights the claim.  No reason (excuse) offered, just 6 denials of claim for long term disability.  Terms of policy said it is supposed to start at two weeks.  Still haven't paid 4 months later.  And premium must still be paid to keep the "insurance" in force during the time off.  Yeah...there is no need to watch the insurance companies in this country.
Colonial Penn Insurance company.  Again, looking out for the customer.

Sure is a good thing we got an insurance commission and commissioner to protect the interests of the citizens of this state.

[Townsend]

Senator seeks to stop Oklahoma agency's 'police posture'

http://newsok.com/senator-seeks-to-stop-oklahoma-agencys-police-posture/article/3734301?custom_click=rss&utm_source=twitterfeed&utm_medium=twitter

OKLAHOMA CITY (AP) — A state senator says he's concerned about the Oklahoma Insurance Department's purchase of police vehicles, shotguns and other law enforcement equipment, and plans to introduce a bill to stop what he described as the agency's "police-like posture."

Republican Sen. Harry Coates of Seminole said Monday he believes Insurance Commissioner John Doak is engaging in "government overreach." Coates says the department shouldn't give the public the impression that the agency's anti-fraud investigators are a police force.

The Associated Press reported last week that the agency had spent more than $180,000 on seven police-package vehicles, shotguns with mountable lights and bulletproof vests.

Doak defended the purchases, saying the items were needed to keep his fraud investigators safe and citing a Louisiana case in which two insurance department agents were shot and killed.

[guido911]

Classic cases of insurance fraud.  Just gotta love Okrahoma!

Case 1.  Injured at work.  Fought the workers comp claim all the way.  Company fired the person after two months off injury, since they filed a claim.  Even though previous performance reviews were glowing.  Finally court, with real doctors (3 of them) instead of the insurance hack.  Ordered to pay for surgery and therapy.
AIG Insurance.  No big surprise there.   Looking out for the customer every step of the way...


Case 2.  Injured at home.  No workers comp involved, but surgery and 8 weeks off work.  Company supplied long term disability insurance fights the claim.  No reason (excuse) offered, just 6 denials of claim for long term disability.  Terms of policy said it is supposed to start at two weeks.  Still haven't paid 4 months later.  And premium must still be paid to keep the "insurance" in force during the time off.  Yeah...there is no need to watch the insurance companies in this country.
Colonial Penn Insurance company.  Again, looking out for the customer.

Sure is a good thing we got an insurance commission and commissioner to protect the interests of the citizens of this state.

Any of that BS happens again, need to contact me.

[heironymouspasparagus]

Any of that BS happens again, need to contact me.

The companies just waited them out.  Both are now back to work - both with reduced functionality, but at least able to go through the motions without major disability.  Major financial hardship for both for 7 and about 12 months respectively.  Neither can do exactly the same jobs they did before (reduced function part), but are getting by.  Just took about 1 year longer than it should have if there had been proper performance by AIG or Colonial Penn. 

Oh, and I guess after the initial court order to AIG, there was apparently a follow on court appearance required to order them to perform the order from the first court adventure...??  So, the net effect was - yes, you are gonna have to pay in the first session.  Second session required to say "Pay".  Made no sense to me....

[guido911]

Just an FYI for termination & work comp.

http://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=463127

A. No employer may discharge or, except for nonpayment of premium, terminate any group health insurance of any employee because the employee has in good faith:

1. Filed a claim;

2. Retained a lawyer for representation regarding a claim;

3. Instituted or caused to be instituted any proceeding under the provisions of this act;

4. Testified or is about to testify in any proceeding under the provisions of this act; or

5. Elected to participate or not to participate in a certified workplace medical plan as provided in this act.

B. No employer may discharge any employee during a period of temporary total disability solely on the basis of absence from work.

C. After an employee's period of temporary total disability has ended, no employer shall be required to rehire or retain any employee who is determined to be physically unable to perform assigned duties. The failure of an employer to rehire or retain any such employee shall not be deemed a violation of this section.

D. No employer may discharge an employee for the purpose of avoiding payment of temporary total disability benefits to the injured employee.

E. An employer which violates any provision of this section shall be liable in a district court action for reasonable damages, actual and punitive if applicable, suffered by an employee as a result of the violation. An employee discharged in violation of the Workers' Compensation Code shall be entitled to be reinstated to his or her former position. Exemplary or punitive damage awards made pursuant to this section shall not exceed One Hundred Thousand Dollars ($100,000.00). The employee shall have the burden of proof by a preponderance of the evidence.

[RecycleMichael]

Thanks guido. That is good information every employer and employee should know.

[heironymouspasparagus]

Just an FYI for termination & work comp.

http://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=463127

Works for the top 53%....

That quote was pretty much how I understood it - these two have moved on - I tried hard to get them to do something at the time, but sometimes 'ya just do stupid stuff (these reactions to those situations).  What can you say...?

Thanks for the info, and next time, I will force them to call.  Well, if you call putting a gun to their head and making them dial "forcing"....

[patric]

Senator seeks to stop Oklahoma agency's 'police posture'

Apparently insurance commissioner Doak got a raging hardon when he rode with OHP this Thanksgiving:
http://www.tulsaworld.com/news/article.aspx?subjectid=11&articleid=20121123_11_A16_CUTLIN381722

And the apparent result was for him to militarize the insurance office:

Sen. Harry Coates, R-Seminole, said he believes Insurance Commissioner John Doak's office is engaging in "government overreach" and that the department shouldn't give the public the impression that the agency's anti-fraud investigators are a police force.

"Why would we want the insurance examiners and auditors to roll up to somebody's building in a police-outfitted unit, unless it was to intimidate them?" Coates said. "If he wants his guys to wear a bulletproof vest, I don't have a problem with that, but stay out of police vehicles. Don't roll up there with your shotgun standing up in the rack with your light bar and all that."

The Associated Press reported last week that the agency had spent more than $180,000 on seven police-package vehicles, shotguns with mountable lights, and bulletproof vests for its nine-member anti-fraud unit, which typically investigates white-collar insurance crimes. The purchases raised concern among lawmakers from both parties who described the equipment as excessive.

Some lawmakers also came to Doak's defense. State Sen. Bill Brown, a retired insurance company owner and chairman of the Senate Retirement and Insurance Committee, said he supported the agency's anti-fraud efforts "100 percent."
Brown wrote the bill two years ago that created the anti-fraud revolving fund Doak's office used to buy the police equipment.

"There is no reason to have a shotgun in the vehicle. Good grief," Coates said. "Wear normal, business-type apparel when you go do an audit and quit being confrontational to these clients."

Coates said he will introduce a bill next session to require the commissioner's office to use standard state vehicles from the motor pool like most state agencies and get rid of the police-package vehicles and shotguns. He said his legislation also would clarify which agency personnel can have weapons and restrict the use of police-style vehicles.

Other lawmakers question why the agency's nine-member anti-fraud unit which primarily investigates white-collar crimes needs equipment typically used by police officers and SWAT teams.

"I don't think Oklahomans as a whole are going to relish the day when their neighborhood is full of official police-package insurance department police cars as they're executing an arrest on a guy who did a fraudulent insurance claim," said Rep. Jason Murphey, R-Guthrie, chairman of the House Government Modernization Committee and a long-time critic of what he perceives as excessive government spending.

"For the life of me, I never could come to grasp with why the insurance department couldn't take a local sheriff's deputy, or someone responsible to the local community, with them when they do these arrests," he said.

According to Insurance Department records, the agency this year purchased five 2012 Dodge Chargers for $23,590 each and two 2013 Chevrolet Tahoes for $26,505 apiece, each outfitted for police.

The agency also purchased seven Remington pump-action shotguns for $699 each, along with seven mountable shotgun lights that cost $203 apiece and seven bulletproof vests that cost $625 each.

The expenditures were first reported by eCapitol, an online service that tracks bills for lobbyists, state agencies and private organizations.

"Is Al Capone back in town?" asked Rep. Richard Morrissette, D-Oklahoma City, referring to the legendary Chicago mobster. "Are we looking for stills in the woods? Come on, it's a joke."

"We serve a lot of warrants, and people are very, very distressed when a fraud investigator shows up at their door," Doak said. "I don't want anyone at my office shot and killed because they weren't adequately trained.

Doak said he has placed a greater emphasis on the department's anti-fraud unit since he was elected in 2010. He also recently began working with local law enforcement agencies to establish vehicle insurance checkpoints, and recently joined the Tulsa County Sheriff's Office at a checkpoint operation there. Doak said he plans to expand that practice in 2013.

Doak also stressed that the expenditures were not from state appropriations, but rather from a revolving fund created by lawmakers two years ago that receives money from fees, fines, penalties and settlements. The account is used to fund the agency's anti-fraud division and received a huge boost last year when $1.6 million was deposited as a result of Oklahoma's portion of a multi-state settlement with insurance and financial services company American International Group, or AIG.

Before the expenditures were made, Murphey said officials at the insurance department had told him they feared lawmakers would take money from the revolving fund and spend it in other areas of the state budget.

"I think the department was afraid that the Legislature would see that balance and raid the fund, so they went looking for investment opportunities, and this was one of them," Murphey said. "I really counseled against it and expressed some concern."

In an Aug. 31 email to Michael Copeland, the head of the department's anti-fraud unit, Murphey also voiced his concern about the agency using law enforcement vehicles.

"I believe the aesthetics of police units with the Department of Insurance markings are terrible from a public perception point of view," Murphey wrote. "Additionally, since the department is led by an elected official this action could certainly create the perception that the markings are in place for political reasons."


Most of the money came from the state settling with AIG, but wasnt that money supposed to go to defrauded insurance policy holders, and not some slush fund to pacify someones envy?

[Conan71]

Doak is a moron.  I think he got elected mainly due to party line voting.

[Townsend]

Doak is a moron.  I think he got elected mainly due to party line voting.

All of his signs and commercials talked about his Christianity.

[nathanm]

If they needed cars, fine. I understand that sometimes it's cheaper to buy through a state's volume deal. Why exactly are they buying shotguns and body armor, though?

It's pretty funny that some legislators are upset about this, though. They continually vote for increasing militarization of OHP and local police forces. I guess some criminals deserve better treatment?

[Conan71]

If they needed cars, fine. I understand that sometimes it's cheaper to buy through a state's volume deal. Why exactly are they buying shotguns and body armor, though?

It's pretty funny that some legislators are upset about this, though. They continually vote for increasing militarization of OHP and local police forces. I guess some criminals deserve better treatment?

The insurance department's compliance officers are essentially auditors not jack-boot thugs that's why the whole mental picture of this is hilarious.  Doak claims that people want enforcement of auto liability insurance laws.  Ostensibly the insurance department could now enforce those laws with spiffy new police cruisers, shotguns, and kevlar vests.  I wonder if he will send his officers to the police jargon school so they can say cool stuff like "un-sub", "perp", and "on his person".

Can you picture an FDIC auditor walking into a bank in full riot gear with his scatter gun slung over his shoulder? 

[patric]

The insurance department's compliance officers are essentially auditors not jack-boot thugs that's why the whole mental picture of this is hilarious.  Doak claims that people want enforcement of auto liability insurance laws.  Ostensibly the insurance department could now enforce those laws with spiffy new police cruisers, shotguns, and kevlar vests.  I wonder if he will send his officers to the police jargon school so they can say cool stuff like "un-sub", "perp", and "on his person".
Can you picture an FDIC auditor walking into a bank in full riot gear with his scatter gun slung over his shoulder? 

I wonder if you could legally order them to take their shotguns out of your place of business?


More from the Whirled:




Former state Attorney General Drew Edmondson said he was also puzzled by the purchases.

"I'm trying to think what the justification might be, and I can't think of any," said Edmondson, when the expenditures were described to him by the Tulsa World.
Edmondson said he hasn't discussed the spending with state Insurance Commissioner John Doak, but his years in state government have proven to him that the anti-fraud unit's work is exclusively in white-collar crime.
Edmondson said that when arrests have been made, the uniformed officers on the scene came from local agencies, except when the suspects simply surrendered.

Doak said funding the purchases is legitimate and comes from the department's anti-fraud revolving fund at no cost to taxpayers.

"We have to do all we can to protect our law enforcement officers including the members of the Oklahoma Insurance Department's anti-fraud unit," said state Sen. Bill Brown, R-Broken Arrow, chairman of the Senate Insurance Committee.

"There's no reason for John Doak to be rolling up to a business or any other area in a SWAT-style vehicle mounted with shotguns," said state Sen. Harry Coates, R-Seminole. "That's insanity."  But Coates questioned if the real motive of the effort was protecting the fraud investigators or raising Doak's public image for political purposes and intimidating insurance companies into complying with state investigators.

"John Doak has visions of himself ... running for the U.S. Senate or something," Coates said. "He's paying for all these ads with someone else's money."

Collins said that the equipment was paid from the department's anti-fraud revolving fund, which is funded by fines obtained in insurance-related crimes, settlements related to misconduct by insurers, late fees and penalties.
http://www.tulsaworld.com/news/article.aspx?subjectid=336&articleid=20121209_16_A1_ULNSon774687&r=1879#3252698

[heironymouspasparagus]

It's easy to understand the motivation - they wanted some cool toys to play with - pure and simple.

[guido911]

He'll be the next Oklahoma Senator. I assume this is happening now: