Shady clinics bilk $1.3 billion in bogus car insurance claims scam

Came across this article.

thestar .ca

Hey Canadians, wonder why we pay so much for insurance? Take a look. I also have this to add:

I used to work for 2 major insurance companies in Canada. In one company I worked as Auto Property Damage Adjuster, the other I was an Accident Benefits Adjuster (meaning I dealt with injury cases resulting from car accidents) what the article says is all 100% true. Many clinics and law offices abuse the system in place.

However, there is another finger to be pointed here. And it is at the insurance companies themselves. Both of the major companies I worked for had very, and I mean very, poor, outdated systems in place. From the computer software to the way we received and delivered information, it is poorly set up. The insurance adjusters them selves are underpaid for the amount of stress a job like this brings, not just with the work itself (dealing with very upset people all day) but the fact that it is a call center environment. Meaning while they are dealing with outdated software and in-effective methods of receiving mail, they are tied to phone lines.

Ask any insurance adjuster and they will tell you the same thing.

Now while all this is happening, the clincs and law offices who recognize that insurance companies are over worked continue to pound home the forms. The adjusters have so much on their plates (as well as managers) that MANY invoices, and treatment plans are accepted and paid for with little to no question. sometimes up to $2000.00 at a time, even when they are obviously not something that should be paid for. Accepting and paying for invoices and treatment take FAR less time then denying and fighting the payment. From an adjusters point of view its simple, accept more then you deny and you will get more work done meaning your bonus is higher. You are far more likely to get into trouble as an adjuster paying something and moving it along, rather then taking the time to investigate.

So I suggest that the insurance companies should take a real look at themselves as well.

- Ghandi



Oh, and I quit the insurance world in the summer of last year. The above is a big reason.

Congrats on becoming part of the solution instead of the problem.

Now if only ATS employees could do the same.

reply to post by Ghandi


What you say about the systems is true for many large corporations.. I worked for one of the largest insurance companies in the US and our entire system was a horribly crappy DOS based system. If I needed to look up a client I would have to type in commands to open the search menues.

It was worse for a large bank I worked for (P&C insurance specialist). This bank is one of the top 5 largest banks in the World and their systems were entirely DOS based as well. I understand not needing the flashy bling of Windows 7 and modern data entry abilities .. but the rate in which those system crashed and have been hacked is quite sad. Their reasoning was that it cost to much to buy new software and hardware that will be outdated the next year. Granted.. we were using a 12 year old system...

Originally posted by jude11
Congrats on becoming part of the solution instead of the problem.

Now if only ATS employees could do the same.

Damn!

Just came back and read my post again...I meant TSA, not ATS...lol

But someone starred it anyway!

oops...

Too late to edit so apologies to Mods and the OP!