http://www.insulttoinjury.org - Printable Version updated August 21, 2005
"I've got nothing against profits, but they are not supposed to be made by lying, cheating, and defrauding people - by destroying their lives." - Ray Bourhis, Insult to Injury
"Ray Bourhis continues his strong commitment to justice by successfully taking on the insurance industry and criminal fraud in this compelling case study. He makes it clear that we need to do much more to end the shameful abuses of the current system and guarantee honorable insurance coverage for every American." - Senator Edward M. Kennedy
If you've ever had to deal with an insurance company to get the benefits
you paid for you've probably wondered if the system is designed
to get you to give up and go away.According to Ray Bourhis, that's exactly what has happened in an
industry fueled by greed and facilitated by a system of
checks and balances that has ground to a halt.Through the compelling stories of ordinary people who have been evicted from their homes and driven into bankruptcy as a result to fraudulent claims practices by insurance companies Bourhis shows how the industry has avoided accountability to the extent that neither lawsuits, punitive damage awards, federal court injunctions, television exposes nor newspaper headlines can derail their pursuit of profits.
"This isn't a little deal anymore. Corporate hotshots aren't stealing thousands and hundreds of thousands of dollars; its million and hundreds of millions. And they're not stealing from the rich and giving to the poor. They're stealing from the poor and stuffing it in their tailored pockets."
continued from above:Bourhis, a national champion of policyholder rights, walks readers through both Joan Hangarter’s heart-wrenching case and the stories of Susan McGregor, Stuart Gluck, John Tedesco, Laurie Hindiyeh, Eugene Molfino, Julie Guyton, Michael Baldwin, Margaret Santana, and numerous other claimants — real people with heart disease, AIDS, spinal injuries, brain damage, Parkinson’s disease, and other disabilities whose benefits were cut off just when they needed them most. Bourhis shows how the world’s largest disability carrier, UnumProvident, has relied on a host of shady practices — from surveillance to one-sided medical evaluations to policy re-interpretations — to target and terminate benefit payments.
Through these cautionary tales, he shines a spotlight on widespread bad faith doubledealing by insurance providers and details the key regulatory failures that enable these practices to continue unchecked.
"Painstakingly documented, hilarious, and insightful. A seething indictment of the out-of-control insurance industry and its friends in Congress and on the U.S. Supreme Court who have given it a green light to defraud Americans." Amy Bach Executive Director, United Policyholders.
Ray Bourhis has taken the compelling personal stories of four people who were wrongly denied disability benefits and woven them into an account showing how insurance corporations' fraudulent behavior has run unchecked and ruined the lives of ordinary, honest Americans. The book shows how we may think we are protected but are, in fact, at the mercy of companies who only care about their bottom line.
Despite federal regulation of everything from our waterways to banking to the use of offensive vocabulary on the radio, the government is actually prevented by law from enacting any insurance consumer protections. This book will strike a chord for all who care about how the checks and balances we count on can, and do, fail us at times when we need them the most.'
Congresswoman Lynn WoolseyThe Author
"…The bottom line is that it pays to cheat. Big time." Ray Bourhis, Insult to Injury
Ray Bourhis - About the Author
Ray Bourhis is a partner with the law firm of Bourhis & Wolfson in San Francisco, California, specializing in insurance bad-faith litigation. A graduate of Boalt Hall at the University of California, Berkeley, Bourhis has been a court-appointed Special Master overseeing reforms in the California Department of Insurance and was appointed by U.S. Senator Barbara Boxer to her Federal Judicial Selection Advisory Committee. He was recently profiled by Ed Bradley in a 60 Minutes report concerning fraudulent insurance practices. Born and raised in Elmhurst, Queens, Bourhis credits an attempt by gang members to throw him into a blazing bonfire at the age of twelve with helping him develop the survival skills needed to deal with insurance companies. He lives in Kentfield, California.
"Under Provident's new corporate philosophy, the claims department began aggressively searching for reasons not to pay claims. Methods would be developed. Strategies would be deployed. Obstructions would be raised, delays instituted, and medical determinations challenged." - Ray Bourhis, "Insult to Injury"
The Book
"The bottom line is this: our corporate ship has sprung a big leak. Hell, it didn't really spring anything. A handful of greedy, silk-suited pirates have been busy chopping holes on the hull searching for hidden bullion. We've got to get them off the damn boat. We need to take a sword to their britches and force them to walk the plank so they can get soaked like the people they're spending their careers cheating. Don't worry, the barracudas won't eat them. Fish have more sense." - Ray Bourhis, Insult to Injury
Insult to Injury: Insurance, Fraud and
The Big Business of Bad FaithOVERVIEW
Getting insurance companies to pay for individual claims is a problem so common it's endemic. And the very real fear that our health, disability, homeowners, and other insurance providers will not be there to pay for claims in the event of catastrophic loss is widespread and well justified. As San Francisco-based attorney Ray Bourhis found out, at least several giant disability insurers-including the largest disability carrier in the world, UnumProvident-made it company policy to cancel benefits in order to increase revenues by hundreds of millions of dollars. These claims were rejected and the policies cancelled regardless of their validity. And for a company with some 25 million policy holders, the abrupt termination of disability benefits meant that thousands of lives and millions of dollars in benefits were put at risk.
In the case of Joan Hangarter, a single mother who bought a disability policy in 1990 to protect her should she ever fall seriously ill, the cancellation of her policy led to personal devastation for both herself and her children.
Joan had dutifully paid her annual premiums for nearly a decade. Yet after she became disabled, her insurer UnumProvident, stopped paying her benefits. As a result, Joan and her children were evicted from her home, and Joan was forced into bankruptcy and onto welfare, leading her to fall and into deep clinical depression. All of this happened to Joan as a result a cost-cutting measure: employees of UnumProvident had "targeted" her for cancellation without ever having spoken with a single doctor who had actually treated her. Eventually, with the help of her attorneys Ray Bourhis and Alice Wolfson, Hangarter won a landmark $7.7 million jury verdict against UnumProvident.
In Insult to Injury: Insurance, Fraud, and the Big Business of Bad Faith Bourhis uses the dramatic story of Joan Hangarter's case-along with the cases of Susan McGregor, Stuart Gluck, Alan Gross, John Tedesco, Laura Hindiyeh, Eugene Molfino, and others-to show how insurance companies are getting away with denying valid claims, terminating benefits, and destroying lives. Bourhis shows how insurance companies put profit above the protection of those who diligently pay for their coverage month after month and year after year. Bourhis exposes the comprehensive systems insurance companies have for targeting and terminating expensive claims without just cause. He reveals the back-room strategic mindset that drives these illegal practices, how low-level employees are duped into unethical conduct, and how insurers manipulate data in the few cases that do go to trial. He also explains the key regulatory oversights that enable these kinds of practices to continue unchecked, and how recent U.S. Supreme Court decisions and the inaction of the current majority in Congress actually facilitate insurer fraud.
Hangarter's was not an isolated case, and her settlement, while welcome, was singularly rare. Unfortunately for us all, as Ray Bourhis points out, this single victory was not enough to change the way these companies do business. To change this system, Bourhis closes Insult to Injury with a roadmap for reforming the insurance industry, so that cases like Joan's become a thing of the past. He also makes the case against so-called "tort reform," showing why it is actually a gift to the monied interests of large corporations and a threat to the legal rights of us all.
Consumer Help
"Under Provident's new corporate philosophy, the claims department began aggressively searching for reasons not to pay claims. Methods would be developed. Strategies would be deployed. Obstructions would be raised, delays instituted, and medical determinations challenged." Ray Bourhis, Insult to Injury
Insurance Consumer Help
Bourhis & Wolfson Insurance Policyholder Representation
Contact
"Insurance companies had to be held to a higher standard than other corporate wrongdoers. What they were selling, in the first place, was peace of mind." Ray Bourhis, Insult to Injury
Contact Information
For all interview requests and review copy requests, please contact:
Peg or Kelly at Booth Media Group
760-929-1111
kfrost@boothmedia.com
pegbooth@boothmedia.comContact Ray Bourhis
email:
rfbourhis@aol.com
Postal Mail:
Ray Bourhis
Insult to Injury
1050 Battery Street
San Francisco, CA 94111Endorsements
"Ray Bourhis continues his strong commitment to justice by successfully taking on the insurance industry and criminal fraud in this compelling case study. He makes it clear that we need to do much more to end the shameful abuses of the current system and guarantee honorable insurance coverage for every American." -
Senator Edward M. Kennedy
"What has happened to Joan Hangarter - and so many others like her - is a grave injustice…. Readers of this book should urge their congressional representatives to force the big insurance companies to honor their obligations just as the holders of those policies honor theirs." -
John Garamendi, Insurance Commissioner, State of California
Ray Bourhis has taken the compelling personal stories of four people who were wrongly denied disability benefits and woven them into an account showing how insurance corporations' fraudulent behavior has run unchecked and ruined the lives of ordinary, honest Americans. The book shows how we may think we are protected but are, in fact, at the mercy of companies who only care about their bottom line.Despite federal regulation of everything from our waterways to banking to the use of offensive vocabulary on the radio, the government is actually prevented by law from enacting any insurance consumer protections. This book will strike a chord for all who care about how the checks and balances we count on can, and do, fail us at times when we need them the most.'
Congresswoman Lynn Woolsey
"Painstakingly documented, hilarious, and insightful. A seething indictment of the out-of-control insurance industry and its friends in Congress and on the U.S. Supreme Court who have given it a green light to defraud Americans."
Amy Bach Executive Director, United Policyholders.Insurance News
"How is it possible that the same federal government that oversees communications, banking, manufacturing, pharmaceuticals, energy, securities…and practically everything else (from the use of dirty words on the radio to the permissible size of mud flaps on tractor-trailers) has not enacted a single antifraud law regulating insurance? Easy - it's all about lobbying." Ray Bourhis, Insult to Injury
Insurance News
Answers from Ray Bourhis regarding the UnumProvident Multi-State Settlement
1. Why was UnumProvident investigated?
In response to concerns over its claims handling practices and to verdicts and appellate rulings in the Hangarter, McGregor and other cases, a "Settlement Agreement" was entered into between UnumProvident and state insurance departments in 47 states.
2. What are the terms of the Settlement?
Under the terms of the Settlement, UnumProvident will be paying a $15 million fine. In addition, UnumProvident agreed to reopen and reevaluate up to 215,000 disability claims it had denied since 1997. It is extremely unlikely that all of these claims were unlawfully denied. What is much more likely is that a small number of claims, involving large amounts of money, were wrongfully terminated.
3. Where can I get a copy of the settlement?
Copies of the Settlement itself, as well as the Multistate Report of the investigation into UnumProvident's claims handling practices, is available at the following website: http://www.state.me.us/pfr/ins/ins_index.htm
4. Did California sign onto the settlement?
No. The California Department of Insurance has rejected the Settlement as inadequate. It is pursuing its own discussions with UnumProvident.
5. What are the problems with the settlement?
There are a number of very serious problems with the Settlement, including the following:
1) It provides for no independent review of the reexamination process. In other words, UnumProvident is left to evaluate its own misconduct;
2) It ignores cases in which UnumProvident underpaid claims rather than denying them. None of these people are eligible to have their claim reassessed;
3) It levies a fine estimated at less than a fraction of 1% of the multi billion dollar net worth of UnumProvident;
4) It forces claimants to waive all their rights to fully recover for losses caused by the claims denial. UnumProvident not liable for forcing people into bankruptcy, or for the emotional distress is caused its claimants;5) It unfairly shifts the burden back onto claimants to prove their case. Even though the company should already have the information it needs to reassess claims, it will still force claimants to dig up years-old documents in order to prove their case;
6) It does not even include all the claims administered by UnumProvident. If UunumProvident denied a claim but the claimant originally purchased his or her policy from John Hancock Life Insurance Company, The Equitable Life Insurance Company, General American Life Insurance Company, New York Life Insurance Company, Metropolitan Life Insurance Company, National Life Insurance Company, Vermont Life, and others, the claimant is excluded from the reassessment process;7) It allows the UnumProvident to continue to use the same insurer-friendly so-called "Independent" Medical Examiners. These physicians then author biased reports that, as UnumProvident's former medical director stated, give the company a "pretext" to deny a legitimate claim. Nothing in the Settlement will prevent this conduct from continuing.
6. What can you do To protect your rights?
You need to speak with an attorney who has actually tried cases against UnumProvident - and who can oversee the reassessment process to make sure the company doesn't simply rubber-stamp a prior claim denial, or use this reassessment process to deprive claimants of their rights to recover for all the damages they have suffered. We believe that the larger the claim, and the longer the benefit period, the more likely it will be that the company will deny or attempt to under-settle the claim.
7. What are the timeframes for the administration of the settlement agreement?
Under the Settlement Agreement, the reevaluation process can take as long as two years. This means that claimants may have to wait two years for the company to decide whether or not it was wrong to have denied a given claim.
8. What are some typical excuses UnumProvident has used to not pay claims?
UnumProvident often uses the same strategies for its claims denials. Typical excuses include: a) contesting or redefining the precise pre-disability occupation of the insured in such a way to support a claim denial; b) disputing the duties an insured is required to perform, or disputing which job duties are "important" with respect to a given occupation; c) claiming that an insured is not entitled to benefits because he or she can perform some (though not all) of their job duties; d) focusing on one medical condition and ignoring other medical conditions; and e) misinterpreting a treating physicians statements to support a claim denial.
Insurance reform
"I'm outraged by the growing element of corporate America that knowingly sells defective products that maim and kill, that creates dangerous blackouts through artificial energy crises, that uses fraudulent tactics to steal retirement benefits from employees, that deploys lobbyists to buy votes and neutralize regulators, and that reduces ethical considerations to a cost-benefit analysis."- Ray Bourhis, Insult to Injury
Insurance Reform - Resources
' We really should be asking ourselves, What in the world is going on here? After all, this is our country. It doesn't belong to the insurance industry. It's bad enough that this kind of thievery takes root in the board rooms of Enron and Halliburton, but to have it happen with insurance companies is really a lot worse.
People buy insurance for peace of mind. Insurance companies have no products per se. What they sell is a promise. What they sell is their word that if your life falls apart, if your income disappears, if your house burns and everything you own is destroyed, they will be there to step up to the plate for you. We really need some special rules for this industry: rules with teeth in them, rules that protect people no matter where they live and whether they bought their policies at work, at home, or over a cup of coffee at Starbucks. ' -- Ray Bourhis
If you’ve ever had to argue with an insurance company over a perfectly legitimate claim, you’ve probably wondered if insurers design the system to get you to give up and go away.
According to Ray Bourhis, that’s exactly what the big insurance companies do.
Insult to Injury is a call to arms that should be heeded by policyholders and lawmakers everywhere. If you hold an insurance policy—and most of us own several—you can’t afford to ignore Bourhis’ advice.
Resources and Information
State Departments of Insurance (DOI)
Address and phone numbers that may be used to request assistance with insurance problems.United Policyholders
One of the most informative and useful consumer advocacy sites on the net!Press Release and Articles
Includes published articles, press releases and news archives.
