Chalaki Law

Insurance companies and fraud scheme involving chiropractors and attorneys

People usually correlate “Ambulance Chasers” to personal injury lawyers with the impression that attorneys are permitted to approach an accident victim immediately after the accident. Although this behavior might take place with some attorneys, I am proud to say that Texas Disciplinary Rules of Professional Conduct strictly prohibits such unethical behavior.

Proudly attorneys are one of the most regulated professions where our ethical and professional conducts are strictly scrutinized to protect the consumers and the general public. As the officers of the law we take pride in our ethical and professional conducts creating comfort and trust with our clients while providing them with competent representation.

Gladly, the doctors and the medical professional that you seek medical treatment from are regulated akin to such Disciplinary Rules. However, it is unfortunate were a few violate these Disciplinary Rules and hurt the general public. People involved in an accident suffer severe injuries which requires immediate medical treatment. It is unfortunate when they fail to get properly compensated for these injuries due to people’s abuse of the system.

***1 “In four related cases, the Massachusetts Superior Court has awarded about $6.7 million to insurance companies against chiropractic clinics and their owners that participated in a fraudulent claim scheme involving staged automobile accidents.

The cases include three initially filed by Blue Hill Chiropractic Group Inc. against insurance companies for failing to pay claims it submitted for patients who supposedly received chiropractic treatment after car accidents. An insurance company initiated the fourth case against several clinics and chiropractors.

The cases are as follows: Blue Hill Chiropractic Group Inc. v. Commerce Insurance Co.; Blue Hill Chiropractic Group Inc. v. Encompass Insurance Co.; Blue Hill Chiropractic Group Inc. v. Premier Insurance Co.; and Norfolk & Dedham Mutual Ins. Co. v. Cohen Clinics.

Both the insurer-filed complaint and the insurance company counterclaims and third-party claims in the other three cases allege that the clinics, owners and their employees participated in a fraudulent billing scheme.

The insurance companies’ legal claims against the chiropractic parties included violations of the Racketeer Influenced and Corrupt Organizations (RICO) Act and the Massachusetts Consumer Protection Act, civil conspiracy, fraud and abuse of process.

In separate May 10 judgments, Associate Justice John Cratsley awarded more than $3.8 million to Commerce, about $1.2 million to Encompass, $1.3 million to Premier and about $455,000 to Norfolk & Dedham Mutual.

In a combined April 22 order, Cratsley granted the insurance companies’ motion for summary judgment on damages and their motion for an assessment of damages and entry of final judgment.

In the order, Cratsley explained why he concluded that a jury trial on damages was unnecessary despite earlier orders bifurcating liability and damages. Cratsley relied on a 1994 ruling by the U.S. Court of Appeals for the 1st Circuit in Aetna Cas. & Sur. Co. v. P&B Autobody. That case upheld a District of Massachusetts ruling that there were “no genuine issues of material fact” about damages. According to Cratsley’s order, the Aetna case involved fraudulent car insurance claims as opposed to chiropractic claims from staged accidents. But as in the chiropractic insurance fraud cases, the case involved fraud, civil conspiracy and RICO claims.

David O. Brink, the litigation manager at Smith & Brink in Braintree, Mass., who represented the insurance companies, called the ruling a landmark decision. Brink said he believes the issue of culpability for paying so-called runners — people who refer patients who then get chiropractic services covered by insurance — is one of first impression.

“It’s the first time that a Massachusetts court has found expressly that the payment of runners represents fraud, unfair business practices under [the state’s consumer protection law] and a violation of the federal RICO statute,” Brink said.”

At the Law Offices of Sean Chalaki, our goal is to protect you and your loved ones before the accident and protect your rights after the accident. Do remember it is illegal for attorneys and most professionals to directly or indirectly solicit an individual immediately after he/she has been involved in an accident. Next time you are involved in an accident and you are approached by a “Runner” at your house or at the scene of the accident, please contact the proper authorities and report them. Then contact our office at 972-793-8500 regarding your car accident and let our professional attorney inform you about all your rights. We Respect you, Understand your situation, and are Committed to earning your trust by providing the professional service you have inquired about.

*** 1 The information above was obtained from (Sheri Qualters, The National Law Journal May 19, 2011)

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