Generally, insurance companies don’t make their money from the
monthly premiums you pay. That money goes to investments, meaning
the company’s finances depend largely on market interest rates and
returns. But how might an insurance company compensate for falling
rates over which they have no control?
to Ray Bourhis, an attorney whose firm took on the country’s
largest disability insurance firm, the answer is: If rates won’t
budge, maybe the claims of policyholders will.
The high interest rates of the 1980s created a boom period for
the insurance industry. When market predictions foresaw continued
high rates, three major providers began selling disability packages
that included fixed premiums, anticipating ongoing investment
revenues would cover the impact of long-term claims. But they
By 1994, companies like Provident began making their claims
departments more stringent, Bourhis writes in CorpWatch.
Among other initiatives, Provident began to administer independent
medical examinations (IMEs) using company-picked doctors. The shift
broke an intuitive and fundamental rule that should govern the
insurance business: The financial status of the provider should not
influence the process by which one determines a claim valid or
invalid. Or, simply put, the health of a company should not
determine that of its clients.
What’s to keep insurance companies from abusing their claims
systems? According to Bourhis, certainly not the federal
government, thanks to legislation passed in 1945 that forbids the
creation of any federal insurance consumer protections whatsoever.
State governments, on the other hand, have regulatory agencies that
conduct investigations that, at best, administer often negligible
fines that merely punish the provider rather than help a wronged
The only way for a defrauded claimant to be rightfully
compensated is if she privately sues an insurance company, facing
off with legions of legal experts. However, Bourhis writes, since
1987, when the US Supreme Court ruled disability policies purchased
through the workplace are no longer subject to state lawsuits, many
policies seem to have become immune to legal repercussions
— Ty Otis
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Fraud in the Insurance Industry
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