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$45,000 Non-Pecuniary Assessment for Persistent but Not Disabling Soft Tissue Injuries

Monday, August 29th, 2016

Today’s guest post comes from B.C. injury claims lawyer Erik Magraken

Reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, assessing damages for persistent moderate soft tissue injuries.

In today’s case (Matharu v. Gill) the Plaintiff was involved in a collision which the Defendant was found liable for.  She suffered moderate soft tissue injuries to her neck and shoulder which persisted to the time of trial and were expected to linger for sometime after although the ultimate prognosis was generally favorable.  In assessing non-pecuniary damages at $45,000 Mr. Justice Butler provided the following reasons:

[30]         When I consider the medical opinions and the evidence regarding the nature and duration of Ms. Matharu’s symptoms, I arrive at the following conclusions:

a)       Ms. Matharu suffered a moderate soft tissue strain to her neck and shoulders. She also suffered a mild low back strain.

b)       Ms. Matharu’s pre-existing conditions have affected the length of time it has taken and will take for her to recover from the injuries. In particular, the inflammatory polyarthropathy made her more susceptible to persistent soft tissue pain. Her mild anxiety condition has also had some impact on the persistence of her symptoms.

c)       In spite of persistent pain for three years, Ms. Matharu has continued with most activities at home and at work. She has managed to do this with the assistance of family, friends and work colleagues. She can fairly be described as somewhat stoic.

d)       Ms. Matharu did not follow Dr. Sanghera’s recommendations to continue with physiotherapy and active rehabilitation for about 12 months. Similarly, prior to the accident, she did not take part in recommended regular exercise. Her failure to do so for a period of time after the accident has likely resulted in some prolongation of symptoms. However, it is unlikely her symptoms would have resolved by trial, even if she had continued with the recommended therapy.

f)        Ms. Matharu continues to experience symptoms related to the injuries suffered in the accident. The symptoms will continue to resolve and there is a good chance they will fully resolve within the next one to two years.

[37]         When I examine the circumstances in this case and the factors highlighted in Stapley, the important factors here are the length of time Ms. Matharu has suffered ongoing soft tissue pain, the extent of that pain, and the impact it has had on her ongoing activities. In that regard, I accept that she is stoic and has continued to do most things. However, I also find that she was frail and somewhat limited in what she could do before the accident. Accordingly, the injuries have imposed a limitation on her activities and lifestyle which has impacted her more than such injuries would have done to someone who was more vigorous and did not suffer from inflammatory polyarthropathy.

[38]         In all of the circumstances, I conclude that a fair award for non-pecuniary damages is $45,000. However, that does not end the matter. Ms. Matharu did not follow Dr. Sanghera’s recommendations and I have accepted his evidence that had she done so she would likely have had some improvement in her symptoms. Accordingly, I find the defendant has satisfied the onus to prove that Ms. Matharu failed to mitigate her loss. I would accordingly reduce the non-pecuniary damage award by 10%.

U.S.A. – Life Insurance Industry Under Investigation

Sunday, August 28th, 2016

Recently 60 Minutes broadcast a segment on the Life Insurance Industry systematic and systemic practice of avoiding the payment of life insurance death benefits was aired.  The transcript of *Not Paid* can be read of the segment viewed at:

When you take out a life insurance policy, you pay premiums in the expectation that when you die your spouse or your children will receive the benefit. But audits of the nation’s leading insurance companies have uncovered a systematic, industry-wide practice of not paying significant numbers of beneficiaries.

In a little-known series of settlements, 25 of the nation’s biggest life insurance companies have agreed to pay more than 7 and a half billion dollars in back death benefits. However, about 35 insurance companies have not settled and remain under investigation for not paying when the beneficiary is unaware there was a policy, something that is not at all uncommon.

The beneficiary never comes forward because he or she doesn’t know the policy exists.

But the companies know, says Kevin McCarty, the insurance commissioner of Florida, who led the national task force investigating the industry. And the companies don’t pay, he says, unless a beneficiary makes a claim.

Kevin McCarty: And what we found is that companies have actual knowledge in their files that people have died, yet they have neglected to initiate an investigation and pay the claim.

Lesley Stahl: So in other words, life insurance companies are failing to pay out death benefits when they know the person is dead, and they’re claiming they don’t know.

Kevin McCarty: In many cases, that has been exactly what we have found.

$95,000 Non-Pecuniary Assessment for Chronic Pain and Somatic Symptom Disorder

Sunday, August 28th, 2016

Today’s guest post comes from B.C. injury claims lawyer Erik Magraken

Reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, assessing non-pecuniary damages of $95,000 for a plaintiff suffering from chronic pain and a somatic symptom disorder following a vehicle collision.

In today’s case (Dabu v. Schwab) the Plaintiff was involved in a 2011 collision the Defendant admitted fault for.  The Plaintiff injured her neck back and shoulder and developed chronic pain syndrome along with a somatic symptom disorder with a relatively poor prognosis.  In assessing non-pecuniary damages at $95,000 Mr. Justice Steeves provided the following reasons:

[51]         Overall, there are findings of physical limitations and an undisputed psychological disorder that are related to the 2011 accident. These continue and they affect the life and work of the plaintiff. I note that Dr. Shane opines that the prognosis is that the plaintiff’s psychological functioning will remain stable. From his previous comments about the persistence of somatic symptom disorder and chronic pain syndrome I take his meaning to be that these conditions will continue. This is generally consistent with the prognosis given by Dr. Misri that the prognosis is poor, if not guarded (based on different diagnoses). There is also evidence that the plaintiff’s symptoms are slowly improving and her specialist in physical medicine and rehabilitation believes she can increase her activities and she should do so…

[53]         In the subject case the plaintiff has managed to work full time and this brings her considerable satisfaction and contributes positively to her emotional well-being. However, she is not able to work at the same level as before the accident and her home life has become reduced in a significant way so she can recover from and rest for work. She also has limitations in what she can now do at work. This is discussed in more detail below under loss of future earning capacity. As a matter of non-pecuniary damages it is enough to say that the plaintiff has not lost the enjoyment that her work gives to her but there has been a related loss because of the limitations her pain and suffering have placed on her home life.

[54]         As above, the defendant relies on prior decisions for her position that the range for non-pecuniary damages in this case is $40-50,000. For example, in the Matias decision non-pecuniary damages were assessed at $50,000. However, in that case bilateral frozen shoulders were found to be very significant for the plaintiff’s disability but they were found to be unrelated to the accident in dispute. In Chen, a decision from 2004 where non-pecuniary damages of $35,000 were awarded, there were soft tissue injuries somewhat similar analogous to the ones in the subject case but the psychological diagnoses related to pain were absent. The Rabiee judgment can be similarly distinguished.

[55]         With respect to the authorities relied on by the plaintiff for her range of $128,000 to $135,000, in Poirier an award of $100,000 for non-pecuniary damages was given but the plaintiff’s condition was likely permanent and the prospect for improvement was guarded. In Hosseinzadeh there was significant pain to the point of rendering the plaintiff immobile for days at a time (at para. 103) and damages of $125,000 were awarded. Damages of $130,000 were given for non-pecuniary damages in S.R., where the trial judge accepted an expert opinion that the plaintiff would not fully recover to her former self despite completion of a pain program (at para. 169) and her ability to participate in one of her most passionate goals in life, her faith, was limited (at para. 172). Finally, in Morlan, the plaintiff could no longer work in her pre-accident work which brought her considerable satisfaction. The Court of Appeal considered non-pecuniary damages of $125,000 to be generous but not excessive.

[56]         In the subject case the plaintiff’s own expert believes she can increase her activities at home and at work and she continues in her work which brings her considerable satisfaction and enjoyment.

[57]         With the above in mind I conclude that an appropriate amount of non-pecuniary damages in this case is $95,000.00.

$175,000 Non-Pecuniary Assessment for Mild Traumatic Brain Injury and Chronic Pain

Sunday, August 28th, 2016

Today’s guest post comes from B.C. injury claims lawyer Erik Magraken

Adding to this site’s archived cases addressing damages for traumatic brain injury, reasons for judgement, reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, assessing damages for a mild traumatic brain injury and chronic pain.

In today’s case (Mayer v. Umabao) the Plaintiff was involved in a 2012 collision.  Liability was disputed but the Court found the Defendant fully at fault for the collision.

The Plaintiff sustained a mild traumatic brain injury and suffered from cognitive dysfunction.  The court found some of this dysfunction was due to the head injury and the rest due to chronic pain and other factors also linked to the crash.  In assessing non-pecuniary damages at $175,000 Madam Justice Young provided the following reasons:

[246]     I am satisfied on the basis of Dr. Chahal’s evidence and Dr. Krywaniuk’s evidence that Mr. Mayer did suffer some trauma to the left side of his head resulting in vestibular difficulties and symptoms of a mTBI. The trauma may have been caused by an acceleration/ deceleration trauma or it may have been caused by a blow to the left side of his head. I find most convincing Dr. Krywaniuk’s evidence. If there was damage to the left vestibular apparatus at the accident then it is likely that the adjacent area of the brain also suffered some trauma. The adjacent area of the brain is the area of the brain that moderates receptive language input where Mr. Mayer reports he has difficulty.

[247]     Having said that, however, I find that the brain injury was quite mild and only affected higher level speech and executive functioning or the ability to multitask. I come to this conclusion because I believe that if the mTBI symptoms were more than very mild, they would have been picked up by Dr. Koss who I find to be a very thorough and careful practitioner who has special training in the area of concussions. The symptoms of brain injury became apparent at work and when judging wine. The irritability, personality changes and memory loss are more likely caused by the long term effects of pain, sleeplessness, anxiety and Mr. Mayer’s somatoform disorder…

[253]     On balance of all of the evidence, I find that the vestibular injury, mTBI and somatoform disorder were caused by the accident and all of them are compensable…

[270]     There are many obvious similarities between these cases relied on by the plaintiffs and the Mayer case, however, I find that the cases relied on by Mr. Mayer’s counsel involve more significant brain injuries which were readily apparent because of the dramatic effect it had on the plaintiffs. Mr. Mayer’s brain injury was more subtle and went undetected for a considerable period of time because of his ability to function. Nonetheless he is a changed man and he has suffered a considerable loss in his enjoyment of life, family, friends, social interests and vocational interests. I conclude that Mr. Mayer is entitled to an award of non‑pecuniary damages in the amount of $175,000.

Six big home insurance misconceptions

Sunday, August 28th, 2016

Rerun – Source: CBC

Standard exclusions aren’t always immediately clear, however. Still, there are some general limitations and misconceptions homeowners should make themselves aware of:

30-day vacancy rule If you’re a property owner whose rented house remains vacant for more than a month, your insurance company can deny coverage for any losses such as fire or water damage. The 30-day rule applies whether or not the customer is paying monthly insurance bills. “It can only be vacant for 30 days without notifying your insurance company, and then technically the coverage is void,” Orr said. “If somebody owns a rented dwelling, and the tenants move out and it might be a month or two before you move back into it, that’s a concern.” Owners can still obtain what’s called a vacancy permit from their insurer, so the coverage never ceases after the occupants have moved out. However, this add-on, which must be purchased within the 30 days, is typically limited to exclude malicious acts and vandalism. A primary difference between a “vacant” and an “unoccupied” property is whether furniture is inside, indicating the owner intends to return. Snowbirds, for instance, could still leave for months at a time, and their homes would be considered unoccupied. Jewelry covered only up to a limit Home insurance only covers for the theft or loss of precious jewelry up to a “sub-limit” that could end up vastly undervaluing such items. Some firms might offer coverage for up to $5,000 or $6,000, Orr said. Brian Maltman, ‎executive director for the General Insurance OmbudService, which handles insurance disputes for Canadians, recommends consumers get their fine jewelry appraised and purchase an extension to their policies. To do this, they would probably have to provide supporting documentation such as photographs to prove the worth of their high-valued possessions. Limitations for rare items Stuart and Annie Brown lost their St. John’s home in a house fire on Dec. 23, 2013. While the couple assumed they would be covered for the value of all the contents in their home, including certain antiquities collected from around the world and valued at $396,000, the Browns were out of luck. Johnson Insurance only offered a quarter of that amount. Orr said the limitations apply for items such as stamp collections (usually $1,000) and coin collections (usually $500) unless extensions are purchased. Sewer backups, earthquakes not covered by basic policies People are often surprised to learn that a sewer backup isn’t included in their basic policy, but only through a specific policy extension. Up until a few years ago, sewer backups were a part of many basic policies. “Overland flooding is the kind of natural catastrophe that’s sometimes considered beyond the capability of a company to respond to,” Maltman said. “Earthquake insurance is similar. One earthquake could wipe out the industry.” Despite the fact sewer backup was not covered for many customers, RBC Insurance decided in 2013 to pay Albertans for damages related to the catastrophic summer flooding. Maintenance exclusions Poor upkeep of property can be grounds for denying a claim. That’s because a home insurance policy is not an “a maintenance policy,” says Pete Karageorgos, director of consumer and industry relations with the Insurance Bureau of Canada. Though some natural hazards can’t have been avoided, other problems could have been taken care of in the first place. “If there’re cracks in your foundation, well, your home is not built so that water seeps into your foundation,” Karageorgo says. “That’s a maintenance issue, not an insurance issue.” The same goes for damage inflicted by household pests. If critters have gnarled away at the attic to the point where a new roof is needed, standard insurance won’t help much. “Toronto is undergoing the war with the raccoon now, but damage done by that raccoon, or a squirrel, or any vermin to a person’s home has an exclusion there,” Karageorgos said. Upgrades could affect policy A few renovation or remodeling projects at home can also have big consequences on your insurance policy, Karageorgos says. “If you’re adding living space by finishing your basement, you’re adding value and costs,” he says. “You need to let the insurance company know you’ve updated the countertops, put in natural stone or upgraded the cabinetry.” Extensive alternations can also change the policy classification, bump up the replacement cost of your home, or lower premiums. “If you have a bigger home than what you’ve told the insurance company you had, when you have a claim and the insurance company discovers that material change in risk, that’s a no-no,” Karageorgos said. “The company may decide not to pay the claim, or they may cancel your policy, or pay the claim and deduct what the additional cost of insurance would have been had you been honest with them from the word go.” Insurance brokers strongly recommend homeowners carefully dig into their property insurance policies to find out what they’re covered for. Anyone with questions can also consult the Insurance Bureau of Canada, or take up grievances with the General Insurance Ombudservice.

Insurance Myths: Earthquakes

Sunday, August 28th, 2016

Source: Softac Systems Ltd.
The myths surrounding earthquake disaster relief and earthquake insurance may result in reliance on government assistance, but because earthquakes are an insurable hazard, earthquake insurance is needed to mitigate the risk of financial loss. In BC, fire insurance covers fire from any cause including earthquake generated fire but insurance companies are lobbying to exclude earthquake fire from standard fire insurance.

Myth #1:

“If there is a major disaster and we lose everything… the government will step in to bail us out!” In the event of a catastrophe anywhere in Canada the federal government will provide financial assistance to the provincial or territorial government affected. This program is administered by Public Safety Canada. Disaster Financial Assistance Arrangements (DFAA) They look to the province or territory to spend these funds on important institutions and infrastructure and to support individuals and businesses that have suffered loss. However, any funds disbursed by the local government will be according to the set of rules established by the province or territory, and there are exclusions. Specifically, if an expense could be insured, repairs or relief are not eligible for reimbursement.

Myth #2:

“Well then… the province will bail us out… won’t they?” To help those impacted by a disaster to cope with the cost of uninsurable repairs and recovery from related property damage, the province has instituted the: British Columbia Disaster Financial Assistance Program This program is administered by the Provincial Emergency Program. Following a disaster those affected may apply for financial assistance with losses that could not be insured. It must be noted that earthquakes are an insurable hazard. Homeowners and businesses are expected to insure themselves.

Earthquake Insurance Reality #1:

The insurance industry provides earthquake insurance called “Shake” coverage. This insurance will cover damage done by the actual destructive shaking of a structure that causes a complete or partial loss of the property. What most people do not realize is that because of modern building codes and construction techniques, most structures will survive usual earthquake events in the mid-magnitude range, but damage may still be considerable, and most of these “Shake” policies come with a usual 10% deductible. That means on a half million dollar property, the first $50,000 will come out of our pocket. Further, the greatest risk to property caused by an earthquake is the fires that always follow! The “San Francisco Earthquake and Great Fire” destroyed the city in 1906. Kobe, Japan following the 1995 earthquake lost 8,000 buildings to in some cases massive fires that followed that earthquake. There is good news for British Columbians in that “Fire Insurance”, as a matter of provincial law automatically covers “fire from any cause” including blazes that follow an earthquake. The insurance industry has lobbied hard to have earthquake-caused-fires to be excluded from standard fire insurance, claiming that following a quake there just won’t be enough money in the pool to cover all the losses. During the past 10 years the province has resisted attempts by the insurance industry to have changes made to this important protection for consumers. If the insurance companies are this concerned about the risks of earthquake fires here, shouldn’t we be just as concerned?

$90,000 Non-Pecuniary Assessment For Chronic Neck and Back Soft Tissue Injuries

Sunday, August 28th, 2016

Reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, assessing damages for chronic soft tissue injuries sustained in two collisions.

In today’s case (Niijar v. Hill) the Plaintiff was involved in two collisions, the first in 2010 the second in 2012.  The Defendants admitted fault for both.  As a result she suffered from chronic neck and back soft tissue injuries which lingered to the time of trial and were expected to continue into the future.  The Court assessed non-pecuniary damages at $90,000 but reduced this number by 15% finding the Plaintiff failed to mitigate her damages by following some of her physicians advice.  In reaching this assessment Madam Justice Baker provided the following reasons:

[147]     I conclude that Ms. Nijjar suffered soft tissue injuries to the muscles of her neck and back in both the first and the second accident.  The injuries caused by the second accident were more significant and Ms. Nijjar experienced more intensive pain and discomfort of longer duration following the second accident.  She also had pain on the left side of her face, jaw and some left arm pain caused by the inflation of the air bag on her left side and also reported some hip pain.  These complaints resolved within a short time.  Her most significant ongoing symptoms were pain in her neck and upper back; and in her lower back.

[148]     I conclude that Ms. Nijjar made a good recovery following the first accident, although she continued to experience mild symptoms of discomfort, aggravated by certain activities, up to the time of the second accident.   She did not miss work as a security guard after the first accident.  She did take time off from a job with Sears for a period of about two months and did not do any janitorial work for a period of about three months.  She was sufficiently recovered to travel to India three months after the accident and remained there for about two months.  On her return from India she resumed working as a security guard and doing janitorial work.  She attempted to return to the Sears job but was not re-hired.

[149]     Ms. Nijjar had more severe symptoms following the second accident and continued to be symptomatic at time of trial.  Dr. Hershler opined that she suffered soft tissue injuries involving both muscles and ligaments; and a right-sided small cervical disc protrusion caused by the accident that may be contributing to her symptoms; although this remains a matter of uncertainty.  Ms. Nijjar also continues to experience periodic headache which Dr. Hershler believes is cervicogenic.

[150]     The symptoms Ms. Nijjar experienced were not severe enough to cause her to seek relief from prescription medications for more than a couple of months following the May 23, 2012 accident and at times she has not required the use of even non-prescription medication to manage her symptoms.

[151]     I accept that Ms. Nijjar continued to experience neck and lower back pain at time of trial.  Although I have concluded that she exaggerated the severity of her symptoms when testifying at trial, I accept that she continues to have symptoms from time to time.  I accept that she will continue to experience symptoms in future, although I accept Dr. Arthur’s opinion that there will be further improvement with the passage of time; and that the symptoms will also lessen if Ms. Nijjar engages in a regular exercise program designed to improve her back and core body strength.  I conclude that the symptoms in future will generally be mild and episodic and that Ms. Nijjar will be able to alleviate most or all of the symptoms with use of non-prescription analgesic medications…

[194]     Having considered all of the evidence and the range of damages suggested by these authorities, I conclude that an award of $90,000, before deduction for a failure to mitigate, is warranted.  I reduce that award by 15% for the failure to mitigate, and award the sum of $76,500. 

Buyer beware: Things to keep in mind when choosing a home inspector

Sunday, August 28th, 2016

TORONTO — Today, in all but two Canadian provinces, virtually anyone can call themselves a home inspector — regardless of whether or not they have completed any sort of professional training.
Here are a few things for homebuyers to bear in mind when choosing an inspector: Most provinces don’t regulate the industry Only British Columbia and Alberta currently have legislation in place requiring home inspectors to be licensed, while Ontario says it’s planning to introduce regulations this year. While there are myriad designations out there that home inspectors can obtain, the educational requirements to obtain those designations can vary widely, even in B.C. Where inspectors are licensed. Experts recommend doing some research to determine what the various designations mean — and what sort of training is required to obtain them. Word of mouth is key Real estate lawyer Mark Weisleder recommends getting a referral from a friend or family member that you trust — rather than from one of the real estate agents that stands to benefit from the sale. Inspectors who get referral business from real estate agents could be hesitant to point out the flaws in a home so as not to risk that business, Weisleder says. “If a home inspector becomes known for finding too many problems with a house, it’s very possible they may not get too many referrals from realtors,” he says. Insurance matters Some, but not all, inspectors carry errors and omissions insurance, which can protect the buyer if the inspector is negligent. Experts recommend asking to see the home inspector’s proof of insurance. Keep limitations in mind Home inspectors base their opinions on what they can readily see within the home. An inspector cannot see through walls or underneath floors. As such, there are some issues that could slip under the radar of even a highly experienced and well-trained inspector. Experts say it’s important to keep that in mind when deciding whether or not to purchase a home.

15 most famous cases of insurance fraud

Sunday, August 28th, 2016

15 most famous cases of insurance fraud -
  1. HCA/Medicare: In 2000 and 2002, HCA pleaded guilty to 14 felonies, including fraudulently billing Medicare as well as other programs. HCA had inflated the seriousness of diagnoses, filed false cost reports, and paid kickbacks to doctors to refer patients. HCA had to pay the US government $631 million plus interest, as well as $17.5 million to state Medicaid agencies, on top of $250 million already paid to Medicare for outstanding expense claims. It was the largest fraud settlement in US history, with law suits reaching $2 billion in total.
  2. John Darwin’s Death: John Darwin faked his death in a canoeing accident, turning up five years later. He’d been secretly living in his house and the house next door, while his wife claimed the money on his life insurance. They were both sentenced to six years in prison, but released on probation. BBC created a TV drama about their story called Canoe Man.
  3. The horse murders scandal: Between the mid 1970s and mid 1990s many expensive horses were involved in insurance fraud. These expensive horses, often show jumpers, were placed on insurance for accident or death, and killed for the insurance money. The number of horses killed in this manner is believed to be at least 50 and possibly as high as 100. It was the biggest scandal in equestrian sports, resulting in the death of a whistleblower, Helen Brach, in addition to the horses.
  4. John Mango’s fire: A Toronto businessman, John Mango hired someone to set fire to his business for the insurance money. Things got quite out of hand, killing one person during the fire and forcing many families to leave the area until the fire could be put out. Mango was charged with second degree murder on top of his fraud charges.
  5. Swoop and squat: In the 90s, car insurance fraud ran rampant. Cars would purposely get into accidents with innocent people on the road, hoping to score insurance money, and often, they did. These accidents frequently injured drivers, and some were even fatal. These accidents usually earned the orchestrators about $20,000 each.
  6. Michael Jackson’s prescriptions: Lloyds of London has recently filed suit to invalidate an insurance policy taken out by Michael Jackson. The policy covered his “This Is It” tour in the event that it was not successful. The payout was to be $17.5 million, but Lloyds argues that it is invalid because Michael Jackson did not disclose prescription drugs on his application. As Jackson died from an overdose, Lloyds is claiming deception.
  7. The Titanic: Everyone knows the story of the Titanic, but not everyone realizes that some believe it’s part of a conspiracy to pull off a huge insurance fraud. The Olympic, Titanic’s sister ship, was damaged and rendered useless during one of its voyages-and some believe that the Titanic as it sunk was actually the Olympic. Conspiracy theorists note several inconsistencies in the performance and construction of the “Titanic” that indicate the Titanic sinking was a case of swapped ships.
  8. Cooperman art theft hoax: Would you steal your own art for money? LA ophthalmologist Steven Cooperman did. He arranged for a Picasso and a Monet to be stolen from his home in an attempt to collect $17.5 million in insurance money. He was convicted in July 1999.
  9. Martin Frankel: Martin Frankel’s insurance fraud is just one in a long list of financial crimes. He was sentenced to 200 months in prison due to over $200 million in losses to insurance companies. He eventually plead guilty to 24 federal counts of racketeering and conspiracy, securities fraud, and wire fraud.
  10. Bristol-Myers Squibb kickbacks: Regulators in California have gone after Bristol-Myers Squibb for insurance fraud, among other offenses. The lawsuit accuses Bristol-Myers of making payments to high-prescribing physicians, targeting and profiting on the private insurance industry. It is the largest health insurance fraud to be pursued by a California state agency. Additionally, in 2007, the pharmaceutical company paid $515 million to settle with federal and state governments against allegations of kickbacks to defraud Medicare and Medicaid.
  11. Dr. Gupta’s mystery procedures: There’s a nationwide manhunt launched by the FBI looking for Dr. Gautam Gupta. The complaint against him alleges that he submitted claims to Blue Cross/Blue Shield and Medicaid for unnecessary procedures, and even ones that were never performed. The fraudulent insurance claims from Dr. Gupta reached nearly $25 million.
  12. Millionaire insurance fraud: Charles Ingram was first made famous as a fraud when he cheated on Who Wants To Be A Millionaire?, using coded coughs to win. But his deception was further exposed when he was convicted of insurance fraud as well. He placed a suspicious £30,000 burglary claim, and was found to be dishonest, ultimately winning two guilty charges for his fraud.
  13. TAP Pharmaceuticals fraud: The Department of Justice got involved with this pharmaceutical insurance fraud case. TAP Pharmaceuticals engaged in fraudulent drug pricing and marketing conduct, as well as filing fraudulent claims with Medicare and Medicaid. They agreed to pay $559 million to the government for those claims, as part of an $875 million settlement for all criminal charges and civil liabilities.
  14. I get knocked down, but I get up again…and knocked down again 48 more times: With 49 cases, Isabel Parker earned her title as the queen of the slip and fall scam. During her career, she received claims totaling $500,000.
  15. Torching the Malibu: What do you do if you don’t want to pay on your car anymore? If you’re teacher Tramesha Lashon Fox, you get your students to set your car on fire in exchange for passing grades. She’d hoped to get insurance money, but instead lost her job and served 90 days in jail.

Not reading the fine print when buying travel insurance could cost you

Sunday, August 28th, 2016

by Miriam Yosowich
Before settling on a travel insurance policy, go through the fine print and see what you are and are not covered for. iStock.
When planning a vacation, travel insurance is usually a high priority, after all who wants to take chances on their health right? One Surrey, B.C. couple that suffered from chronic illnesses bought insurance before their Caribbean vacation. However, once the policy was used when the wife became life-threateningly ill during the vacation, it reduced her coverage with her regular insurer (even though the travel insurance was with a different company) due to extremely high medical bills resulting from her illness. How could this happen? Likely the couple didn’t read the fine print of their travel insurance. Let’s be honest, most of us don’t read the fine print and we’re usually OK, because either nothing will happen or we’ll have minor injuries which the travel insurance will cover. However, what happens if the injuries are not minor and may be a result of chronic or pre-existing conditions which require an operation and/or extensive treatments? This is where the fine print in travel insurance comes into play. Often if you are dealing with chronic illnesses or pre-existing conditions, the travel insurance can list it as a limitation/exclusion in the fine print and in the end you may not be covered. So before settling on a travel insurance policy, go through the fine print and see what you are and are not covered for, especially if you are already sick. Confused by the legal-ese in the fine print of the travel insurance policy? In that case, it’s often a good idea to contact a lawyer and ask him or her to review the fine print before you buy. Even if you are an employee whose travel insurance is arranged through your workplace that is not an excuse to forgo reading the fine print and have it reviewed by a lawyer. See: Do employees know enough about their travel insurance? After all, not knowing about an exemption could still leave you without coverage.