Washington Insurance Commissioner Deborah Senn has ordered her staff to investigate national allegations that auto insurers rely on “medical reviews” performed by laypersons to deny insurance benefits to policyholders injured in auto accidents.
“This is an issue that we looked at in 1996, making sure auto insurers used the right type of health-care providers to review auto-injury claims,” Senn said. She also invited Washington consumers to report any firsthand trouble they had experienced with “medical reviews” and auto claims.
Senn said Washington state has consumer protections in place that should prevent improper denials. She noted that “Dateline NBC,” which reported the allegations in June, also acknowledged that Washington is one of four states that has reacted to the problem.
“There are serious allegations about companies who do business in the state of Washington, and we want to be sure that the industry is adhering to the rules we have spelled out,” Senn said. In 1997, the department adopted regulations that require insurers to use “like licensure” providers. This means that, if the patient sees a chiropractor, the insurance company cannot have the treatment reviewed by an orthopedic surgeon who is not trained in chiropractic.
Senn said she had ordered six of the largest carriers doing business in Washington state to submit claims data so her investigators can be certain that Washington consumers are getting the benefits they pay for in their auto insurance policies.
The new allegations were raised in a “Dateline NBC” program in late June. The program said auto insurers today rely upon “medical opinions” from nonprofessionals to deny valid claims. The six companies targeted by the investigation are State Farm Mutual Insurance Co., Safeco Insurance Co., Farmers Insurance Co. of Washington, Pemco Insurance Co., Mutual of Enumclaw, and Allstate Property & Casualty Co. Together, the six account for approximately half of the auto insurance sold in the state annually.
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