Litigation involving insurance fraud, casualty law, and issues related to health care law is often complex, requiring an extensive knowledge of state and federal law and regulations. In health care and insurance fraud cases, verdicts often turn on how the Current Procedural Terminology (CPT) codes or the Healthcare Common Procedure Coding System (HCPCS) are interpreted and employed in adjudicating claims. In reimbursement or subrogation matters, the results achieved depend upon knowledge of the health plan contract, the administrative remedies available and ERISA (Employee Retirement Income Security Act). Successfully resolving such casualty and health coverage disputes necessitates a solid understanding of case law and precedent, so you need results-driven advocates and attorneys who know and understand trial procedures, and who have successfully protected the rights of other carriers in complex legal matters.
Cockerill, Craig & Moore, LLC can help. All our lawyers have decades of courtroom experience. One of our partners is certified as civil trial attorney. To learn more about the services we provide to insurance carriers, contact our office online or call us at 856-440-1231 for an appointment. We know that your case is important to you…it’s important to us, too.
In Defense of Premium Payers and Insurance Carriers
At Cockerill, Craig & Moore, LLC, we appreciate how fraudulent claims affect what everyone pays for insurance. We protect the interests of premium payers and insurers who have written any type of policy of coverage, including contracts providing:
- Comprehensive General Liability, or CGL insurance
- Casualty or property loss insurance
- Health insurance
- Workers’ compensation insurance
We defend all types of claims under an insurance policy, including tort claims (such as product liability actions), consumer fraud claims and declaratory actions over coverage disputes.
Fraud Recovery, Reimbursement and Subrogation Claims
We represent health benefit plans in recovering benefits paid for the treatment of a member or insured whose medical expenses were necessitated by the wrongful conduct of another because of a work-related injury. Recovering such benefits is for the benefit of the plan and its participants and helps control the costs borne by employers and their employees for health insurance coverage. We represent insurance carriers as plaintiffs where insurers have been the victims of fraudulent or wrongful conduct, whether it results from an opportunist who files a one-time claim for losses not suffered, or the work of a “fraudster” – someone whose business practices are set up to increase profits through false insurance filings. We will work closely with forensic accountants and economists, billing codes experts, claims adjudicators, fire investigators, and other professionals to build the most compelling case for your recovery. Our attorneys know that issues of insurance fraud require proof that the policyholder, a vendor, or health care practitioner provided a false or misleading statement in support of an application for insurance or a claim for benefits that they are not entitled to. We have the deep background and knowledge to discern when there has been a false or misleading statement of a material fact such as:
- Overbilling, double billing, upcoding, unbundling or billing for medical procedures not performed
- Claims filed for property not lost or stolen or injuries not suffered
- Workers’ compensation claims for pre-existing conditions or for injuries sustained outside of the workplace
- False claims for disability or wage loss
- Payment of kickbacks or unlawful referral fees
- Waiver of patient’s or claimant’s financial responsibility (deductibles, co-pays or co-insurance)
Our attorneys also represent insurance carriers in subrogation claims, helping you seek reimbursement from other insurers for costs you have incurred because of the wrongdoing of their insureds.
Contact Cockerill, Craig & Moore, LLC
To learn how we can help you, contact the Woodbury insurance carrier attorneys online or call us in Woodbury, New Jersey, at 856-440-1231.