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OAI: Abuse of NY Auto Insurance System Highlighted by New Initiative

The DFS will soon have the option to investigate medical care providers and possibly exclude them from getting no-fault benefits.

RANCHO CUCAMONGA, CA, March 12, 2012 /24-7PressRelease/ -- A recent announcement from New York Gov. Andrew Cuomo saying that new capabilities would be granted to the state Department of Financial Services to help penalize medical care providers who abuse the state's no-fault system highlights the problems New York and other no-fault states have had keeping suspect claims out of those systems, according to

No-fault or personal injury protection (PIP) coverage was originally designed to be an affordable car insurance policy that got its cost savings from keeping car accident victims out of the court room. In theory, it did this by paying for the policyholder's own medical damages through his or her own policy, regardless of fault, rather than making them seek compensation from the at-fault party, which is what happens with the alternative, liability coverage.

But insurers in Michigan, New York, Florida and New Jersey have all said that PIP insurance abuse is eroding their bottom lines, with unscrupulous medical providers inflating claims and bad-intentioned residents staging accidents in order to cash in.

Numerous reports from the Insurance Research Council (IRC) have indicated that the no-fault abuse problem in New York City has reached huge proportions.

According to an IRC report released in January 2011, about 1 in 5 claims closed in the New York City area appeared to have elements of fraud, leading the IRC's senior vice president to call the level of abuse and excessive billing "truly stunning" when compared with other parts of New York. In other parts of the state, the rate of claims that had indicators of fraud was closer to 1 in 20.

As a result, the state Department of Financial Services (DFS) has been given the authority to go after medical providers that appear to be abusing the system and to ban them from getting no-fault benefits in the future.

An announcement from the DFS says it has already identified 135 providers "whose billing practices have raised concerns." The DFS will contact these and other medical care providers and require them to provide information on their business structures and billing procedures, and scrutinize them.


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