Bad faith is the unreasonable failure of an insurance company to honor the terms of an insurance policy and deal with a policyholder in good faith. Insurance companies who are found to have acted in bad faith can be liable for punitive damages in addition to contract damages. Some states have bad faith statutes called "Unfair Insurance Claims Practices Acts."
Insurer Lawsuit Claims Former District Manager Cheated on Bills
November 26th, 2012 - Combined Insurance Co. of America has sued a former employee who it accused of submitting nearly half a million dollars worth of bogus claims tied to his insured medical emergency.
The ACE Group unit said that David W. Thomas and his wife, Debbie L. Thomas, jointly conspired and actively participated in a fraud tied to their purchase of a Combined-issued hospital confinement indemnity policy.
Thomas, of Jonesboro, Ark., had bought the non-cancellable, guaranteed renewable policy in 2005. Prior to 2006 he was diagnosed with cirrhosis of the liver and in 2006 underwent a liver transplant. His medical treatment took place at hospitals in Jonesboro or Memphis, Tennessee.
Combined said in its suit that Jones submitted a number of valid claims for in-hospital care but also submitted 18 bogus claims for hospitalization and emergency room visits. The claims in question covered 50 separate periods of time.
Combined said that Thomas submitted false billing information from the two hospitals where he was treated. Further, he allegedly presented false attending physicians’ statements that verified his hospitalization. To do this, he allegedly used either a prior physician’s statement or forged the signature of his attending physician, Dr. Brad Moore.
The fly in the ointment appeared when documents were presented to Combined bearing Moore’s signature after Sept. 21, 2007, when the physician died.
To further their deception, Combined said the defendants sent it messages detailing the declining health of David Thomas, including falsely stating that “we almost lost David last night” and that he had been admitted to a hospice.
In its suit, filed in US. District Court in Jonesboro, Combined asked for $448,000 in damages from bogus claims. And based on the conduct of the defendants it asked to cancel the policy that is otherwise non cancellable until Thomas reaches age 75.
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