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In previous posts, on the LEX & CO blog we have alerted you about fraudulent insurance managers, who promise their clients that they will be exempt from paying deductibles or coinsurance on medical expense policies. The Mexican Association of Insurance and Bond Agents (Amasfac) urged insurers to take legal action against the actors involved in these cases. Today we will tell you everything you need to know.
It is estimated that at least 20% of accidents involve fraudulent insurance managers who, in complicity with hospitals and doctors, increase the price of treatments, diagnose unnecessary conditions or operations to increase costs and thus defraud both the insurers as well as the insured.
Given the increases in cases, some insurers choose to request at least two medical evaluations to verify that patients really need the recommended treatment to avoid unnecessary increases in the costs of hospital care.
The high level of claims represented by this type of fraud causes million-dollar losses to insurers, is a direct blow to clients’ finances and, finally, increases the price of medical expense insurance policies, which reduces access to these services.
The national president of Amasfac urged insurers to criminally prosecute those who commit fraudulent actions of this nature, as well as their accomplices. In addition, he asked the authorities to create a regulatory body in order to eliminate practices that directly affect all those involved in insurance fraud.
Insurers have realized that insurance managers, along with doctors and clients, want to make the policy valid for interventions that are not covered, such as cosmetic nose surgery, disguising it as an accident. However, if the practice is detected, the insurer may withdraw coverage and the client will have to assume the full cost.
Associations such as Amasfac or AMIS (Mexican Association of Insurance Institutions) have also urged clients not to trust external agents, not to give them money in advance or additional payments, or to believe in supposed benefits such as eliminating or reducing the deductible. since this could be fraud.
At LEX & CO we recommend that you only approach qualified insurance agents to purchase policies and resolve your doubts. Avoid falling into inappropriate behavior and protect your finances.
If you have complied with all the insurance company’s requirements and still do not want to pay, contact LEX & CO. We have a team of insurance claim lawyers in Mexico who will gladly advise you to successfully resolve your case. Write to us through the contact form, tell us your case and Learn the Art of Winning with LEX & CO!
Carlos Figueroa Rodríguez, attorney at law at Lex & Co. He has more than 10 years of experience in specialized cases involving insurance claims and medical malpractice. He is a graduate of the Universidad Anáhuac and has a Master’s Degree in Constitutional Law and Amparo from the National Bar Association. He also has a Doctorate in Juridical Sciences from the UCI Mexico. Professional license 6577215.
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