Insurance company intimidation tactics, Fraud allegations bullying, Manipulate situation by choosing what information is relevant, NC Statutes on unfair claim settlement practices

Insurance company intimidation tactics, Fraud allegations bullying, Manipulate situation by choosing what information is relevant, NC Statutes on unfair claim settlement practices

“For members who have found themselves in disputes with Thrivent, the retroactive change rankles. “You’re wondering how Lutheran organizations can treat their own customers that way,” says Mr. Tiedemann, an 83-year-old retiree who navigated the dispute-resolution process for more than two years before giving up.”...WSJ May 30, 2006

“The insurance companies understand that if they deny and deny claims, then many of the claimants will never pursue their claim,”…ABC News Good Morning America April 25, 2008

“pre-dispute mandatory arbitration provisions are inappropriate in insurance policies and incompatible with the legal duties insurers owe policyholders when handling their claims.”…NAIC, National Association of Insurance Commissioners, August 15, 2016

 

How Do Insurance Companies Use Intimidation Tactics?

“One of the ways an insurance company may try to manipulate the situation is by choosing what information is relevant. If they discover some key information that wasn’t previously communicated to them, they might choose to punish you for not telling them, instead of simply assuming you had made a mistake and asking you to supply the missing information.”

“Unsubstantiated Fraud Allegations: Many insurance providers will allege that their policyholder is engaged in fraud by inflating the value of items in their claim, fabricating events resulting in loss or claiming loss of items that do not exist or were not lost or damaged. Sometimes these allegations will be loosely based on mistakes on a proof of loss form or be completely without any factual support. The objective is to intimidate a policyholder into accepting a lowball offer because of fears that the insured will face potential civil or criminal liability as well as having his or her claim completely denied.”

http://eachstorytold.com/2018/06/30/fraud-accusation-insurance-company-intimidation-tactic-common-intimidation-techniques-tactics-by-insurance-companies-are-unethical-illegal-obligation-of-good-faith-and-fair-dealing-toward-policyh/

From AcomHealth.

“It is a very common device for claims adjusters to allege “fraud” as a means to drive a minimal financial settlement with a provider. The claim by some insurance company employee that “overutilization” has taken place and that somehow, based on self-serving and unreal “guidelines” they are exploring legal action against the provider is, indeed, sobering and probably as intimidating as it is intended to be. As absurd and unethical as this behavior is, it is frequent and it is effective in driving low-dollar settlements by providers even for the most legitimate of claims.”

“While the exact language in the law regarding fraud may vary from state to state, the common elements necessary to prove fraud might be summarized as follows:

Fraud must be proved by showing that the defendant’s actions involved five separate elements:

  1. A false statement of a material fact,
  2. Knowledge on the part of the defendant that the statement is untrue,
  3. Intent on the part of the defendant to deceive the alleged victim,
  4. Justifiable reliance by the alleged victim on the statement, and
  5. Injury to the alleged victim as a result. Source:  Farlex Internet Free Dictionary”

Read more:

https://acomhealth.com/steps-prevent-defend-claims-insurance-fraud/

NC Statutes.

“§ 58-24-165. Unfair methods of competition and unfair and deceptive acts and practices. Every society authorized to do business in this State shall be subject to the provisions of Article 63 of this Chapter relating to unfair methods of competition and unfair or deceptive acts or practices”

https://www.ncleg.net/EnactedLegislation/Statutes/PDF/BySection/Chapter_58/GS_58-24-165.pdf

“(11) Unfair Claim Settlement Practices. – Committing or performing with such frequency as to indicate a general business practice of any of the following: Provided, however, that no violation of this subsection shall of itself create any cause of action in favor of any person other than the Commissioner:
a. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
 b. Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies;
c. Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies;
d. Refusing to pay claims without conducting a reasonable investigation based upon all available information;
e. Failing to affirm or deny coverage of claims within a reasonable time after proof-of-loss statements have been completed;
 f. Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear;
g. Compelling [the] insured to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insured;
h. Attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled;
 i. Attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured;
 j. Making claims payments to insureds or beneficiaries not accompanied by [a] statement setting forth the coverage under which the payments are being made;
k. Making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration;
 l. Delaying the investigation or payment of claims by requiring an insured claimant, or the physician, of [or] either, to submit a preliminary claim report and then requiring the subsequent submission of formal proof-of-loss forms, both of which submissions contain substantially the same information;
 m. Failing to promptly settle claims where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage; and

n. Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement.”

More here:

https://citizenwells.com/

http://citizenwells.net/

 

 

 

 

 

 

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49 responses to “Insurance company intimidation tactics, Fraud allegations bullying, Manipulate situation by choosing what information is relevant, NC Statutes on unfair claim settlement practices

  1. citizenwells

    “May 4, 1923 – March 6, 2011. George Tiedemann went to be with our Lord near midnight Sunday after suffering complications of a long battle with end state renal disease. He passed peacefully in the nursing facility at Brookdale Senior Living.”

    “George and Lucy Tiedemann discovered they had fewer legal rights than other kinds of policyholders when they tried to sue Thrivent. Devout Lutherans, the Niceville, Fla., couple never considered buying life insurance from anyone but the Aid Association for Lutherans, which became Thrivent after it merged with the Lutheran Brotherhood in 2001. But the policies proved far costlier than their sales agent represented, they say, because of overoptimistic projections the agent made in marketing the policies.”

    http://eachstorytold.com/2018/06/24/george-tiedemann-obituary-mr-tiedemann-featured-in-wsj-article-about-thrivent-some-life-insurers-play-by-different-rules-george-and-lucy-tiedemann-navigated-the-dispute-resolut/

  2. oldsailor86

    CW………..
    …………it appears that NAIC sees things a little differently than does Thrivent………….this is in your favor, and should be mentioned in any correspondence you have with them even on a repetitive basis if necessary in parallel with your claim against them. In the event you haven’t yet done so be sure to ask for a formal complaint form to be sent to you. Fill it out and, supplement it with no more that 3 pages of what happened to you, and include it when you return the complaint to the NCAG. DO NOT attempt to deal with the NCIC without the AGs knowledge. Or if you have already been in communication with NCIC regarding the Thrivent matter, be certain to make all of this known to the NCAG.(in writing) and always keep copies of all correspondence accurately filed for future reference. I have a gut feeling that you will need to use every word in your vocabulary many times over before the Thrivent thing is corrected. I am glad that you posted the NAIC statement. It is encouraging.

  3. oldsailor86

    CW………
    In clear cases of Insurance MAL PRACTICE, or FRAUD in a given state it is up to either the STATE AG, or the INSURANCE COMMISSION of that state to correct, or prosecute. Attempting to sue such a company yourself will be costly and also brings unwanted variables into the equation. This is IN PART the reason for proceeding via the NCAG.

  4. citizenwells

    Bingo!

  5. citizenwells

    The pen may still indeed be mightier than the sword. (Remove S & you have word)
    Knowledge is power.

  6. Scott Pruitt had rescinded two of the worst overreaches of the EPA, the 50mpg fatwa, and another rule on diesel trucks.
    Then they all feigned outrage at phony ethical violations that never seem to bother anyone when it’s a democrat.
    Now, the new acting EPA Director has promptly reversed Pruitt’s work on the diesel trucks. And I will not be surprised if he also puts back the 50mpg fatwa on cars, too.

    And that’s what it was all about. EPA rules that the environazis and the scumbags in Washington DC want to use to ride herd on everyone else in the country.

    Instead of backing Pruitt, our glorious republican party stuck a huge knife in the back of the people who voted for them.

  7. Regarding plastic straws–I read this morning Starbucks give paper straws now…wrapped in plastic.
    You can’t make this stuff up!!

  8. citizenwells

    Part of the epidemic of stupid.

  9. oldsailor86

    fhl………..
    ………….and they are capable of a whole lot more. This is why I talk about SNEAKS. Such people are among the lowest forms of humanity, and humanity will do well to never take their eyes off of such people. A SNEAK ALWAYS comes from BEHIND you. A SNEAK will cut your throat in a HEARTBEAT from behind you. They never attack you when they are being observed ……they are FILTHY COWARDS, and represent a large percentage of the LIBERAL LEFT.

  10. oldsailor86

    AND……….
    QUESTION;…………When will the ICE MAN visit the Barry Soetoro residence……….and put him in COLD STORAGE for shipment back to his village in Kenya.

  11. CW,

    The NC statutes are clear as a bell.

    Does Thrivent think they’re above the law (like many of our politicians)? Do they think they can do as they please and to hell with the laws of the state?

  12. oldsailor85+……….

    I have a question regarding plastic straws in Santa Barbara. If garbage has a few plastic straws in it and the garbage is hauled to a land fill disposal site, how do the plastic straws wind up in the ocean? The Santa Barbara landfill is about 5 miles from the ocean. Sorry, just thought of something. Perhaps the drunks are throwing plastic straws off the pier into the ocean and having fun.

  13. hapnHal………
    ……………here is a thought regarding how the straws might be getting from the landfill to the ocean……. maybe gulls are flying around landfills looking for lunch………VOILA he sees a straw and samples it. He discovers there is residual sweet stuff inside so he grabs it and takes off for his favorite spot the BEACH. While he is tasting his prize he is distracted by another gull, and he takes off to fly with the other gull. The tide comes in and away goes the straw. This story was fiction, but GEEZ IT ALMOST MAKES SENSE! har har Hope the flames aren’t getting close to you.!!!!

  14. hapnHal……..
    …………..have you ever gotten the feeling that a helluva lot of Americans have lost their minds completely?

  15. A THOUGHT…….
    ………….you can expend lots of time and resources attempting to IMPEACH A HAM SANDWICH……….but when PUSH COMES TO SHOVE, it will be the SCOTUS which decides if Trump has committed any impeachable crimes. When the smoke clears it will be the POS who perpetrated the failed impeachment, and end up with cells to live in at Leavanworth in reward for their attempt to overthrow a sitting POTUS.

  16. …………it is time for ICE to pay a visit to the Barry Soetoro residence, put him in cold storage, and ship him back to his village in Kenya.

  17. Has anyone heard from Bob Strauss lately?

  18. citizenwells

    No

  19. citizenwells

    bob strauss last comment June 19.

  20. A trannie, in this case a man pretending to be a woman, killed his own grandmother by slitting her throat. In Chandler Az Brandon Smith killed Helen Smith.

    Guess what. The media all refer to him as a man.

    When a trannie commits a crime, it just wouldn’t do to let the world know it was a trannie, now would it. The media will literally kick you off the internet if you don’t refer to a trannie by their gender of choice——unless they commit a horrific crime. And then the fact that they are a trannie must be kept hidden.

  21. Wants to disallow Russians from posting on facebook about politics.

    Wants to let foreigners vote in elections.

    How can anyone tolerate these people?

  22. fhl………..
    ………….don’t know who came up with the Ed Henry joke, but it might be closer to reality than anyone even suspects……in which case I SALUTE Trump. One thing is certain …….he ain’t homosexual, and married to a transgender. Like hapnHal once observed, the POTUS is a PRAGMATIST.

  23. fhl………
    …………do you suppose this could be THE LAST STRAW?

  24. AND TODAY ………
    …………..as I watch the ceremony of the CARRYING OF THE FALLEN from the aircraft, my mind has gone back 65 years. I personally was not involved in any combat operations, rather we were there to assist with and participate in amphibious operations and to retrieve some of the dead and wounded HEROS who gave their ALL. It breaks my heart to watch the ceremony and I personally salute all who fell in combat………..they are true HEROS. They are BROTHERS!

  25. oldsailor86 | August 1, 2018 at 7:57 pm |

    GW,

    Ewww…that was bad [but I laughed 🙂 ].

  26. AND TONIGHT………
    …………..as I watched Tucker Carlson it became very clear that our country is in serious danger of having the last vestiges of our laws circumvented. Now we will all (no matter your age) soon be required to apply for and hold a passport as personal ID. This is TOTAL BULL$HIT. How the hell is a newborn infant going to go apply for a GD passport? PASSPORTS are for travelling IDENTIFICATION, but do not reflect LEGAL BIRTH CERTIFICATION. Legal birth certification comes only from a legally valid BIRTH CERTIFICATE. Oregon, California, and Washington State are handing them out like hotcakes to anybody…..even illegal aliens. If they hold a passport they will be allowed to vote in FEDERAL ELECTIONS within the sanctioning state. It is now time to start arresting and prosecuting the BASTARDS who are behind this . If they do not act our system of voting is NO LONGER SAFE. The SICK , TWISTED POS IN ALL THREE STATES WILL ULTIMATELY PAY A VERY DEAR PRICE FOR THEIR PART IN THIS FALSIFICATION OF IDENTITY. They all need to be sent to Leavenworth for extended slammer vacations!!!!

  27. I BELIEVE…….
    …………that it is not going to be long until roving gangs will be beating people senseless, and probably some will die from their injuries. This is the first insanity which will lead to all out street wars, and subsequently to total CIVIL WAR.

  28. AND NOW………
    …………..we hear that California wants to turn nearly half of the state into a native American reservation. I am wondering what they intend to do about the many celebrities who LEGALLY OWN PROPERTIES in Northern California. There are some folks with very deep pockets living in the area which Jerry Brown wants to turn into an Indian Reservation. This would amount to illegal confiscation of PRIVATE PROPERTY. I have a gut feeling that the property owners will not sit idly by as Jerry Brown confiscates their properties.

  29. QUESTION;
    ……….hapnHal……I am wondering what your take is on the Jerry Brown idea of turning Northern California into an Indian reservation. If he is successful then all Trump people would have to leave, as their properties are confiscated by the State.

  30. oldsailor86,

    I’m still kicking, been busy fighting democrats, and usurper enablers, on Facebook. Last time I tried to post here I had computer trouble and gave up. There is so much information coming out about the FISA fraud right now, it is overwhelming how much info, and disinformation is out there. I’ve been following the Q deal too, still waiting for the schitt to hit the fan! All I can say is those bastards in DC are lucky I am not running the show, there’s a whole bunch of them that would be in GITMO right now!

    If you haven’t seen Trumps speech it’s a good one! MAGA!
    Finally, a president for the people!

  31. Hi SueK,

    Trump’s been a little tough on Lizard Warren, and I love it! You can call her a liar right to her face and she pretends that nobody said a word, sort of like that other lying creep Blumenthal who lied about his service in Viet Nam, he was called out on it, and then pretended nobody said a word, and he’s still in there lying about Trump. Just sickening!

  32. AND NOW ………
    ……….the liberal insanity has come to the court room. The liberal halfwits thought they could prove Manafort’s guilt of a crime because he lived a so called LAVISH life style. Judge Ellis quickly tossed a monkey wrench into their case when he advised the alleged prosecutors that it is NOT A CRIME FOR A PERSON TO HAVE LOTS OF MONEY…..NOR IS IT A CRIME FOR HIM TO SPEND HIS MONEY AS HE SEES FIT. Judge Ellis told the prosecutors that any evidence which they plan to enter which is related to his wealth will NOT be allowed in his court room. Apparently THIS WAS THEIR ENTIRE CASE. AS FOR THE ALLEGED tax evasion CASE IT IS DOUBTFUL THAT IT WILL BE PROSECUTED, SIMPLY BECAUSE IT IS LONG PAST THE STATUTE OF LIMITATIONS WHICH AS I REMEMBER IS 10 YEARS. Unless the law has been changed he will probably walk free, and the liberals will be left with their perennial stupid facial expressions, and a lot of money wasted. These people become more insane as each day passes!!!!

  33. AND TODAY………
    ………….we see evidence of the depth of stupidity which at least one female Senator has demonstrated when she said “I AM CONFUSED” while she attempted to express herself at the Senate hearings. Senator Masie Hirono is without a doubt CONFUSED..….in fact I would venture to say IGNORANT about IMMIGRATION LAWS. If she is an example of the intellectual ability of the members of the Senate our country is in extremely serious trouble.

  34. The New York Times has hired one Sarah Jeong to write for their editorial board.

    Here are some of the things she has said on twitter in the past. If it’s too small click on it to make it a little larger so you can read.

    There is no pretense. The left hates white people. Period. And they think it is acceptable to openly state that they hate white people.

    All while so called republicans cower in fear and saying the slightest thing that some leftard might call racist. It’s pathetic, It’s sickening.

    And we might as well just face it.
    There is no amount of abuse that republicans will not accept.
    The left openly states their hatred of white people. The left weaponizes the federal justice system. The left sends out groups in masks, like antifa, to beat up conservatives……..and the right does nothing at all to stop it.

    There is no more chance of the DOJ and the FBI being held accountable for what they’ve done than there was for Obama being held accountable for his phony credentials. It will not happen.

    Sorry for the sad truth, but why live a delusion? When the left takes guns away, conservatives will dutifully comply, All the bluster to the contrary being written is just bs.

    If the right will do nothing when leftist mobs in masks go out and beat people up, why would anyone think anyone will do anything when they pass laws to take guns away?

    Anyone who wants freedom should be thinking about another country to flee to because it’s only going to get worse here and there is nobody to stop it from happening.

  35. TO WORDPRESS……..
    ………in my comment of August 2 2018 @9:10 AM I expressed a legally valid viewpoint. All of the words used are published in Webster’s New World Collegiate Dictionary, and are therefore legally expressible in the public domain, and media. I deeply resent my Civil Rights being violated by a moderation of my comment. I believe that I have a Constitutional right to express myself in the media. I have not used profanity, nor have I stated an untruth. If WordPress found my comment to be offensive perhaps you will be so kind as to state why it is offensive . In reality it is the TRUTH.

  36. fhl……….
    …………..what were your thoughts when you watched Mzzzzzzzzzzzzzzzz. Hirono say she is CONFUSED. A confused Senator is a Senator who should not be a Senator to begin with. Time to send her back to GRADE SCHOOL!!!!

  37. Mzzzzzzzzzzzzzzzzzzz. Hirono made a complete fool of herself. If she is confused about statutory law then she should have simply not have tried to discuss the law to begin with. I pray that the rest of our Senators are more versed on the law than she apparently is NOT.

  38. O’Keefe Catches Antifa ‘Fight Instructors’ Teaching Activists How To Inflict Pain on Their Targets
    https://pjmedia.com/video/okeefe-catches-antifa-fight-instructors-teaching-activists-how-to-inflict-pain-on-their-targets/

    Veritas gets video of antifa instructing their masked criminals on how to beat people up.

    And Jeff Sessions and Paul Ryan will say and do NOTHING.

    They’re all too busy making sure someone’s civil rights haven’t been violated when someone laughs at a joke about black people or something.

    We live in a lawless hellhole.

  39. This is the dirt bag who set my grand son up on false meth charges that cost me over $20,000… Melisa Gilliam republican attorney is running against the dirt bag and I hear she has a good chance of winning!

    https://m.riverfronttimes.com/stlouis/jerrod-mahurin-st-francois-county/Content?oid=21670615

  40. AND ONE QUESTION………..
    …….REMAINS……….WHY ARE REPUBLICANS AFRAID OF PEOPLE LIKE MZZZZZZZZZZZZZZZZZZZZZZ. HIRONO ? IF SHE IS AN EXAMPLE OF LIBERAL INTELLECT THEN WE REALLY DON’T HAVE ANYTHING TO FEAR FROM HER, OR PEOPLE LIKE HER. THEIR NEVER ENDING HODGE PODGE OF JUMBLED, AND TWISTED WORDS TELLS ANYBODY WITH EVEN HALF A BRAIN THAT THERE IS PATHETICALLY LITTLE BASIS TO ANYTHING THAT THE WORD TWISTERS HAVE TO SAY. MZZZZZZZZZZZZZZZZZ. WATERS IS A CLASSIC EXAMPLE, AND MZZZZZZZZZZZZZZZZZ. PELOSI IS A CLOSE SECOND, FOLLOWED CLOSELY BY MZZZZZZZZZZZZZZZ CORTEZ. MY GUESS IS THAT SOME OF THESE PEOPLE BURNED THEIR BRAINS OUT IN THEIR COLLEGIATE DAYS ON LSD 25 AS THEY TRIPPED OUT ON THEIR HALLUCINATIONS GENERATED BY THEIR FAVORITE DRUGS. TODAY ALL THREE SOUND AS THOUGH THEY ARE SEVERE MENTAL CASES. AS FOR MZZZZZZZZZZZZZZ CORTEZ SHE BEAT SOMEBODY WHO MUST HAVE BEEN A REAL DUMMY……OTHERWISE SHE WOULDN’T HAVE MADE IT TO FIRST BASE. THE GUY SHE BEAT WAS ALLEGEDLY ONE OF THE PEOPLE UNDER CONSIDERATION FOR 2020 DEMOCRATIC PRESIDENTIAL CANDIDACY. I GUESS THEIR LOGO SAYS IT ALL.

  41. bob strauss | August 2, 2018 at 4:28 am |

    Hi Bob,

    Glad you’re still with us!

    My dream ticket for 2020: Liawatha and ‘Red’ Bernie. I’d love to see Trump mop the floor with both of them during the debates :). Maybe Lizard (I like that!) could bring in some members of the Cherokee nation for the debates; I’m sure they’d be proud to see one of their own running for POTUS /sarc.

    A few years ago, WRKO talk host, Jeff Kuhner (formerly of the Washington Times) confronted her about her ‘heritage’ in person; he had her boxed in. She was extricated by her ‘boys’ without addressing the questions, and ran away with her handlers in tow.

    We’re under the impression that she did indeed take a DNA test. No results have ever been published, so that speaks volumes about what was found: Nothing.

    She and Blumenthal were discovered under the same rock…

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