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Proposed Class Action: Progressive Insurance Underpaid Millions in Personal Injury Benefits

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A proposed class action lawsuit filed in Kentucky federal court alleges that the Progressive Insurance Corporation has avoided paying millions of dollars in personal injury benefits for over 15 years. The alleged scheme involves doctors reviewing paper medical records rather than conducting direct patient examinations when determining the value of claims.

The complaint, brought by Bethany Byrd and Taylor Brooks, claims the specific insurers they patronize (within the Progressive Corporation) rely solely on “paper reviews” when determining payouts for personal injury claims. A paper review entails a doctor merely reviewing an injured patient’s claims material and medical records, without an in-person physical examination of any kind. The complainants allege that by neglecting to conduct a thorough physical examination the insurance companies are then able to deny or slash personal injury protection benefits to the tune of several million dollars.

Byrd has auto insurance policies with Progressive Direct Insurance Co. and Brooks has a policy under Progressive Casualty Insurance. Byrd received extensive medical care after an October 2014 car accident, but Progressive Direct used a paper review by a chiropractor to deny paying her more than $2,000 in benefits, according to court filings.

Likewise, according to the complaint Brooks was treated for injuries stemming from a May 2017 car accident, but Progressive Casualty denied payment of her benefits based on a paper review. Neither of the plaintiffs’ reviewers conducted personal medical examinations following their accidents, the complaint says.

Moreover, the complaint states that Progressive allegedly paid the reviewing doctors “to say the same or similar things on nearly all reviewed claims.”

Additionally, “Many of the paper reviews were nothing more than cut and paste jobs from the paper reviewers; the Progressive claims handler would ask the same questions for each review and the reviewer would in turn respond with answers which were either identical or substantially similar for all,” according to the complaint.

Furthermore, court documents allege that, “In addition to Progressive’s reliance upon paper reviews as a basis to deny claims, the insurer also instituted a process of unilaterally reducing submitted medical bills and offering the arbitrarily reduced amount to a provider on a ‘take it or leave it’ basis.”

According to the complaint, the Kentucky Motor Vehicle Reparations Act explicitly bars determining personal injury protection benefits denials on the basis paper reviews.

The plaintiffs are reportedly seeking to represent a class of any Kentucky residents who, by determination of a paper review, had their personal injury protection benefits denied or cut under an automotive policy issued by either of the defendants as of Feb. 12, 2005. The suit states that it intends to recoup the benefits patients contend they are owed, as well as interest accumulated over the years, and attorney fees.

The complaint says the proposed class action is likely to include more than 500 individuals. However, one of the attorneys representing the plaintiffs, Sam Aguiar, stated publicly that he could foreseeably see that number increasing to a couple of thousand victims under the alleged insurance scheme.