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Interview with an insurance claims agent
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Because of the sensitive nature of this interview the agent’s name as well as the company that employs this person will be kept confidential. Suffice to say that this agent works in the Maryland Area, works for a large well known company, and is certified to take claims in a 4 state area.
AR: How long have you been in the insurance field?
Agent: 28 years in health insurance 3 years in auto
AR: What type of insurance claims do you take?
Agent: First party medical bills pertaining to medical bills for auto accidents
AR: How has the current economic situation affected your business?
Agent: More claims from small accidents with claimants represented by attorneys
AR: Do you think claims increase the higher the medical limits?
Agent: Absolutely!
AR: Compared to other neighboring states, how do MD’s limits rate?
Agent: MD $2500 per accident per person, DE is $15,000, VA doesn’t have personal protection they have medical payments $5000 but don’t cover lost wages, WV is $5000 medical pay also doesn’t cover lost wages
AR: Does your company allow illegal aliens to get car insurance?
Agent: Yes, but we only know this from the claimant not having a social security number, we aren’t allowed to ask that question
AR: Does the company have any special dispensations for them?
Agent: The company uses and interpreter line, and the applications for benefits are available in only Spanish
AR: Of all your claims, approximately what percentages are through an interpreter?
Agent: 25%
AR: Do you see fraud on a daily basis?
Agent: Absolutely!
AR: Of all your medical first party claims, what percentage use up the full limit?
Agent: In MD close to 80%
AR: Certainly insurance companies go after fraud, what percentage do you think gets pursued in court?
Agent: Actually the court system tries to persuade the insurance companies not to pursue them, they think that $2500 is such a small amount.
AR: Watching the system being used must be frustrating, how would you change the system to make it less prone to fraud?
Agent: Remove Chiropractors as primary doctors, allow the insurance companies to medically manage claimant’s care. All care for specialists must be referred by primary physician. Claims should be reported before car begins.
AR: In your opinion, is the industry itself enabling fraud, or is it the state mandates?
Agent: State Mandates.
AR: I want to thank you for bringing this problem to light, and taking your time to answer some questions, that quite frankly, are far worse that I certainly thought. Unfortunately once enacted, bureaucracy rarely stops on its own. It seems insurance reform is needed in areas other than just healthcare. State mandates have as much to do with car insurance rates as they do with healthcare, and it’s our state legislators have control of that also.
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