ACC Claimants Call For More Ombudsman Powers

ACC Claimants Call For More Ombudsman Powers

ACC Support-Action Group Canterbury - ACC Support-Action Group Otago

ACC claimants are calling for the insurance ombudsman to have increased powers and some control over ACC practices following further revelations over the weekend that America's largest disability insurance company, UnumProvident, has been fined $1 million after Georgia insurance officials investigated complaints about its claims handling.

Following a stunning rebuke from a Federal Court to obey the law and stop cheating people out of disability payments UnumProvident, the largest disability insurance company in the U.S., has been hit again and fined $1 million by Georgia State Authorities over complaints about its claims handling practices.

Newly elected Californian Insurance Commissioner, John Gramendi, also says that UnumProvident practices appear to him to be a conspiracy to defraud individuals and he is promising a full investigation.

The complaints revolve around UnumProvident denying claims based on its belief there was not enough documentation on file; its hand-picked doctors disagreeing with claimants' doctors and specialists; not enough medical evidence of disability without investigating or obtaining evidence; subjectively deciding a claimant could work when the medical evidence said otherwise; claiming that claimants were not disabled at all; shredding files; employing biased doctors; spying on people; withholding entitlement information; and targeting specific categories of claims for cancellation.

ACC Claimant Support Groups claim that these practices are also common within ACC which is proof positive that the NZ Insurance Ombudsmen or the official Office of the Ombudsmen need to have increased powers and a measure of control over ACC with the ability to levy fines, amongst other things, for breaches of good faith and ethical practice.

UnumProvident has lost lawsuits over the past year totalling hundreds of millions of dollars when more than 3,000 claimants across the U.S. brought charges against it, including fraud.

Like New Zealanders, most Americans have faithfully had money deducted from their wages and salaries to pay disability insurance. In New Zealand ACC collects its money, $2.2 billion annually, by way of compulsory charges and levies which are about to increase yet again.

American lawyers handling dozens of new claims against UnumProvident say people rely on insurance to cover them in the event that they become disabled and cannot work. Law firm Beasely, Allen, Crow, Methvin, Portis & Miles, who is handling claims against UnumProvident from Hawaii to Alaska, say that many people might be in for a rude awakening if they hold an insurance policy through UnumProvident.

In New Zealand claims are being levelled against ACC by lawyers that it has a policy of finite weekly compensation, people are therefore under-insured and, after two or three years, ACC finds ways and means to dump seriously injured claimants.

The U.S. law firm discovered that UnumProvident has systematically and unjustly been denying legitimate claims from seriously injured people. The same complaints are levelled at New Zealand's ACC.

They also discovered that UnumProvident Corporation is a holding company for several other insurance companies and is responsible for adjusting disability claims not only of its subsidiaries, but for non-affiliated companies as well. The law firm says that it has uncovered evidence that suggests the same corporate policy of denying benefits has been implemented by it when adjusting claims for other insurance companies it handles.

Last January 24, a California jury awarded a $31.7 million verdict against UnumProvident to a doctor who could no longer perform operations. The lawsuit said that UnumProvident was focused on profits and thus denied the doctor's claim for disability insurance.

ACC Support Groups are now raising questions about the frequency of visits by ACC executives to the U.S., to whom did they visit and for what purpose.

Some ACC Support Group committee members have heard that NZ claimants have contacted the U.S. law firms by email for an assessment of their alleged claims mismanagement by ACC.

ACC recently received an updated A+ superior rating from America's largest insurance rating agency A M Best. ACC is also a major player in the investment and financial markets with levy-payers funds and plans to have $5 billion invested by 2005.

Claimants say that New Zealand now operates in a global environment. The disability insurance industry and practices of ACC can be just as much under scrutiny on the global scene as they can in New Zealand.