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Auto Insurance Claims/Special Investigations Unit

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Expert: - 1/30/2009


Question
Recently when my claim was being settled, a special investigations unit adjuster called me questioning the therapy I received from the doctor.  WHy would they question that when they had already got my medical records from the doctor.  I received a letter from the insurance company saying some of the services billed I didn't receive.  How do I know what they billed for?  I like the doctor and sure that he wouldn't do that.  Why would the ins company question this?  Am I responsible for the part of the bill that the insurance company is not going to pay?  Please help.

Answer
Hello Michelle,

Obviously, you don''t know what you are being billed for. You didn't state the type of doctor, but Chiros are commonly under suspicion, because (my opinion) they commonly charge for additional services they did not perform. Mine went to prison for tax evasion and medical billing fraud.
I do not know your situation, but I have experienced where the ins would only pay prevailing rate which was much less than the doctors charged, leaving me responsible for the balance.
SIUs have to justify their jobs, so they review anything that may cost them money.



Rob

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Rob Painter, Ase, CFEI, CAFATE

Expertise

Please remember. I am not an attorney and cannot legal advice. My answers are based on my experience due to litigation I have been involved in as an expert, for both insurance companies and while oposing them opposing them. I deal with only comprehensive claims on autos related to fire and theft. I have even had the opportunity to rewrite policy coverage language as it relates to vehicle theft and forced entry for insurance defense attorneys.

Experience

Experience in the area: Working with insurance companies and attorneys on these issues for over 20 years. It is very common to have a reported stolen car with a so-called factory anti-theft system to have the theft claim denied. I have served successfully as an expert witness in the courts across the US representing the insured and their attorney revealing that the insurance expert did not take all known theories into consideration before rendering their "Forensic" conclusion. Many insurance carriers us independent "Forensic" experts to examine reported stolen vehicles commonly using flawed methodology implicating the innocent insured with the theft. My job is to determine if the insurance expert reached his conclusions based on accepted scientific principals or just net opinion with no basis other than opinion. My case record against such experts is very compelling.My resume can be seen at the catagory "Auto Theft and Prevention." In "Forensics" the scientific method must be employed. In the forensic locksmith field determining how a reported stolen vehicle was last operated, many processes cannot be duplicated and are conveniently not addressed. If they were, juries would have the opportunity to make a fair and impartial opinion at least about what the expert could or could not prove. There is a purported process determining the last key used. The chances of determining such is very rare uless the key is found in the ignition lock. Experts commonly destroy evidence as well and are rarely questioned on this event. I reveal the weakness in their testimony on such instances.

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