Portland, OR: A federal bad faith insurance class action lawsuit has been filed against USAA insurance and others, by military families who allege they have been cheated out of medical treatment for injuries related to auto-accidents.
Four plaintiffs, all women, who filed the suit, claim that say USAA Casualty Insurance or one of its clones refused to pay legitimate claims for medical expenses after they had suffered automobile accidents. The named defendants are USAA Casualty Insurance Co., United Services Automobile Association, USAA General Indemnity Co., USAA County Mutual Insurance Corp., Garrison Property and Casualty Insurance, Auto Injury Solutions Inc. and chiropractors Clark Wolf III and Ross Hart.
The suit includes claims that the plaintiffs, including Margaret Soukup who is currently on active duty, were "induced into" hiring USAA as their primary insurer for themselves and their families. "USAA touted its commitment to servicing military families and advertised the 'exclusive privileges of its auto insurance,' noting that, 'For those who stood tall for this country and for their families, we stand ready to return the favor,'" the complaint states.
Soukup alleges that following a rear-end collision in which she was injured, and subsequently submitted a claim for personal injuries, USAA referred her claim to Auto Injury Solutions (AIS), without her knowledge, which put together "sham file reviews" that USAA uses to "uniformly conclude that medical treatment was not needed."
Brittney Bathurst, who was nearly killed in a collision, makes similar claims, alleging that a sham file was created and that the signature on the file review was "an 'electronic' signature;" that "the report states in no uncertain terms that 'A Physician Review has been completed;'" and that that statement "is absolutely false."
Another of the plaintiffs, Amber DeMerritt, claims that following an accident in Oregon, USAA and AIS created "at least four sham file review reports, purportedly created by a George D. Sage, a chiropractor in Decatur, Georgia."
And the fourth plaintiff, Samantha Jones, says the defendants created "nine sham file reviews" and used them to deny her coverage.
They seek punitive damages for the class, for breach of contract, breach of faith, and violations of insurance laws and regulations.
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I have been experiencing the same problem with AIS and getting the run around from USAA. Monday Oct 30th this year, that day I made 6 phone calls to USAA in an attempt to speak with a claims manager.
During these first two calls I was reassured that USAA had my best interested at heart and 21 rehab visits was the maximum chiropractic and massage therapy allowed for what they classified as a “soft tissue injury”.
The claims specialist assigned to my account had not logged in to my file since Sept 20th, that is per USAA claims person on the phone 30 days is standard USAA policy, that was one of the first responses from the claims specialist on the phone.
I asked if they employed an algorithm to determine treatment plans & because it certainly appears they have the claims person would not confirm it only that they had established guidelines.
I asked for a copy of these internal claims guidelines for keeping the member informed on the status of their medical claim and treatment plans.
(Later phone with the claims Manager she would deny this request stating these are internal documents and policy.)
Doing some research I’m finding out this is a common practice with AIS and USAA on medical claims.
Next two calls (3 &4), I was placed on hold and asked to wait for a claims manager, only to have the calls dropped 3 to 5 minutes later.
I called again later in the day (call number 5) I spoke with a gentleman that identify himself as a claims manager only when I asked a direct question if he was a claims manager did he admit he was not .
The 6th person a very nice person provided an extension for a claims manager and transferred me so I could leave a message.
The next business day my call was returned from a claims manager, she stated that they need to see a variant in the treatment program
like physical therapy or acupuncture etc. to justify continued payment of medical claims.
I am currently awaiting an explanation on the payment status of my medical benefits, the claims manager asked the billing info be submitted again
I am sure that the medical provider treating me is using the same medical documentation they used for the first 21 visits that were paid and that they use for other insurance companies.
This is another delay tactic on USAA’s part to discourage my treatment and me getting better & making progress.
They stopped paying the bills for Chiropractic care and massage therapy Sept 14th and the other bills * are under review.
Appears they practice denial and deception on a grand scale to discourage their members from seeking proper treatment for their injuries.
What baffles me is that the person that struck my vehicle is insured by State Farm insurance so USAA is not responsible for the final billing.
Being an US Army veteran this practice is very sad that USAA is plainly taking advantage of people who will give up easily on their claims & rights as policy members of USAA.
Shame on USAA and this treatment of all American Armed Services Veterans.
With Veteran’s Day being around the corner Nov 10th.
I would like to thank all Veterans personally for your service to this great country of ours.
SHAME ON USAA
Posted by Joyce Floyd
My husband and I have had USAA 15 year term life insurance policy for 17 years never missed a payment. At the 17th year (2017) USAA increased our policy premiums on my husband double the amount originally paid. He had $500,000, which USAA decreased to $387,000 on his 70th birthday, my husband died 15 days after his birthday, USAA paid the decreased amount. Now they have decreased my value from to 1,099,000 not once but twice when I turned 66 they decreased to 827,000 now they decreased it $537,000, they increased my payment again also.
By time I'm 70 the policy will have a value of less than $300,000 and they still increased,the payment. I have no medical issues or illness. Yet they think it's okay to take my money and not pay full value at death.
Posted by jim lewis
I CALLED USAA TO COMPARE RATES WITH AND THEIR QUOTES WERE ABOUT FIVE TIMES HIGHER THAN ANYONE I GOT QUOTES FROM! THEY DONT CARE ABOUT THE VETERAN, JUST SQUEEZING ALL THE MONEY FROM THEM THEY CAN GET!
Posted by Tom Thornburg
I'm a disabled Veteran and USAA is my insurance company. I was broadsided by another driver and USAA shorted my Replacement Value of my Lincoln Town Car by 25%. They said it was customary and I could buy an additional 20% added on to any future appraisals for an additional fee.
Then as I had existing combat injuries and one severe spinal injury from 2011 due to VA incompetence my doctor ordered a set of MRI's.
USAA refused to pay for them saying "their doctor said they were unnecessary"... They didn't even send the bills to the other insurance company. When I posted a complaint on their facebook page they called me.
They admitted they didn't want to pay for the MRI and that the other Insurance Company was really the one responsible. I should file a Demand Letter with Star Casualty Insurance.
I had an attorney because I was injured or more accurately my older injuries were severely aggravated. When USAA said the MRI's were unnecessary my attorney said "if your own insurance company abandons you...what can we expect a jury to think...and they dropped the case.
Basically USAA screwed me over all the way around. I have 4 vehicles insured and my house insured with USAA. I am OVER INSURED even if the other driver wasn't at fault my insurance should have covered everything. The other driver was issued an AT FAULT TICKET at the scene.
USAA is a very dishonest company and all that "we care about Veterans" that's all crap, they will screw over a veteran in a heartbeat. They admitted to me that they just didn't want to pay for the MRI ... So I have to go after the at fault insured insurance company.
Your not really insured if your have USAA
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