George Rawlings grabs a stack of computer printouts and stretches them six feet across his office, admiring data from police reports of Florida auto accidents: the names of those hurt and the severity of their injuries.
For Rawlings, this information is gold. It?s his job to track these injured people down and collect money from them.
?Finding personal injury claims is really hard to do,? he says about his trade. ?We invented a way to identify them.?
The Kentucky lawyer is the father of a little-known but burgeoning industry that helped insurers like Aetna Inc. and Kaiser Permanente recover at least $3.5 billion in 2014 alone from policyholders hurt by someone else?s negligence. A growing body of law, including a 2013 U.S. Supreme Court decision, gives health insurers power to recoup expenses for medical treatment.
Critics say people end up being victimized twice, with Rawlings Co., and the competitors that its success has spawned, essentially acting as bounty hunters. Even though they paid their premiums, people often must reimburse insurers out of whatever compensation they receive for their injuries, sometimes leaving them with only a pittance.
?A whole cottage industry has grown up around these health insurance rights, and they?re going after reimbursement recoveries on the backs of the injury victims themselves,? says attorney Matt Wessler, who argued against the practice before the Supreme Court.
To Rawlings, insurers only hire him when their plans spell out that members must repay medical costs. If an insurer didn?t meet its financial responsibilities, he says, ?people would be screaming bloody murder. The insured has obligations in that contract. Are you going to honor the contract or not??
Rawlings Co., owned by Rawlings and his wife, is typically paid about 20 percent of whatever it collects, he says. The company says it has recouped hundreds of millions of dollars for insurers from product-liability cases, including the Silicone Gel Breast Implant litigation, Fen-Phen weight-loss drug case and recent multibillion-dollar settlements involving the painkiller Vioxx.
All but two states ban or limit the ability of health insurers to recover medical costs. However, federal law, which has fewer restrictions, applies to people insured by Medicare and Medicaid, as well as the vast majority of employees for big corporations. While Rawlings won?t discuss his client list, it includes Aetna, Kaiser, and several Blue Cross Blue Shield plans.
Lawsuits provide a glimpse into what the industry can look like. Shaun Miller was riding his bike in California when a van plowed into him, leaving him paralyzed. Although Miller needed millions for lifelong care, the maximum available from the car?s auto insurer was $100,000.
?Fairness and Decency?
Rawlings, representing Kaiser Permanente, demanded more than $33,000 to compensate the insurer for Miller?s medical expenses. Asking Rawlings to consider ?simple fairness and decency,? Miller?s attorney offered $3,500. They compromised at $15,000.
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