Deceptive Insurance Practices
The complaint for this class action claims that insurer USAA hired another company to “review” medical claims submitted to it for Med Pay benefits and that that company used unfair systems to refuse, reduce, or deny claims for benefits for injured people. Some of the bills, the complaint contends, are refused via “coding errors, sham medical necessity reviews, and confidential statistical information, rather than the individual character of health care services required by an insured and their related expenses.” For other ones, the complaint claims that payment amounts are reduced by declaring them “unreasonable” or applying PPO or PPN treatment rates that do not apply to the insureds’ medical providers.
Fay Servicing has agreed to settle a class action alleging that when it required residential borrowers to have LPI (lender-placed or force-placed insurance), it received an unauthorized benefit, causing the premiums for the insurance to be higher than necessary.
Mortgage lender Residential Credit Solutions has agreed to settle a class action alleging that when it required borrowers to have LPI (lender-placed insurance, also known as force-placed insurance) on a mortgage or home equity loan, RCS placed the insurance in a manner that caused it to receive unauthorized benefits, unfairly raising the cost of the premiums.
Carrington Mortgage Services has agreed to settle a class action alleging that whenever the company required a borrower to have LPI (lender-placed insurance, also known as force-placed insurance) it received kickbacks or unauthorized benefits that raised the cost of the insurance. The case concerns LPI issued by American Modern Insurance Group, Inc., American Modern Home Insurance Company, The
Plaintiff Roy Smithson bought an insurance policy that had an investment or savings component that the complaint for this class action refers to as its Accumulation Value. Each month, the complaint claims, the Accumulation Value for the policy is intended to change and grow, according to certain formulas. But according to the complaint, Smithson’s insurance company made deductions not permitted by its policy agreements and so have lowered Smithson’s policy’s Accumulation Value.
Oklahoma plaintiff Rachel Curtis totaled her car on July 4, 2017. Since the car had only 67,000 miles on it, the complaint for this class action alleges that Progressive Northern Insurance Company’s payout was too low. The complaint alleges that the company uses the Mitchell WorkCenter program, which consistently undervalues vehicles, and that Progressive adds to the problem by not choosing vehicles that are actually comparable for the evaluation. According to the complaint, this constitutes fraud or negligent misrepresentation and is contrary to the policies set forth by Oklahoma insurance laws.
In 2014, Valerie Maddox was in a car accident. She got treatment at the Tower Health Center, Inc. and assigned the company her PIP insurance benefits for the accident under her Government Employees Insurance Company automobile insurance policy, according to the complaint for this class action. Yet when Tower applied for reimbursement from the company, the company paid 2% less than Tower was expecting. The complaint for this class action alleges that the cause of the underpayment is a misreading of Florida laws and an attempt to make a Medicare provision apply to Government Employees Insurance Company, a commercial insurer.
During 2013, plaintiff Marlene Williams was in a car accident and was treated for her injuries at Coastal Wellness Centers, Inc. To pay for these treatments, the complaint for this class action says, she assigned the PIP benefits of her Geico car insurance policy to Coastal. Coastal submitted the claim, which bore the medical code 98940, to Geico, but according to the complaint, the reimbursement Geico paid Coastal came up short. The complaint for this class action alleges that the cause is a misreading of Florida laws and an attempt to make a Medicare provision apply to Geico, a commercial insurer.
Like a majority of Americans these days, Dale Miller is not a smoker. According to the complaint for this class action, he was never a smoker while he held his life insurance policies, including during their look-back periods—yet he was charged smoker’s rates for life insurance for years. Miller found out he was being charged as a smoker, the complaint alleges, only in 2016 when he went to reduce his GVUL policy coverage and found, when looking at the price comparisons for coverage, that he should have been paying drastically-lower premiums than he had been paying. Met Life has refused to refund the difference in the premiums, even though the complaint estimates that he overpaid by nearly 20% over sixteen years, a substantial amount.
The complaint alleges that M&T has an arrangement with insurance company ASIC under which ASIC is M&T’s exclusive provider of FPI and also performs mortgage-servicing functions. In exchange, the complaint alleges that ASIC pays M&T kickbacks on FPI, which violates provisions in the borrowers’ mortgage contracts. But this complaint alleges that there’s an even more complex scheme. It claims that M&T pays ASIC for a master insurance policy which covers all of its mortgage loans. When a borrower’s own policy lapses, instead of M&T purchasing a new policy for the borrower, the complaint says, ASIC issues a certificate of insurance from the master policy, so that no individual underwriting ever takes place. The implications of all this lead to allegations of violations of RICO statutes as well as other laws.