New Jersey Disability Lawyer Blog

For the approximately one million Americans living with Autism, proving their rights to insurance proceeds and coverage as well as SSDI may soon become even more difficult.
The American Psychiatric Association has appointed a panel that is reviewing the current definition of Autism as a prelude to publishing the newest version of the D.S.M. Currently, "a person can qualify for the diagnosis by exhibiting six or more of 12 behaviors; under the proposed definition, the person would have to exhibit three deficits in social interaction and communication and at least two repetitive behaviors - a much narrower menu." New York Times Article, January 19, 2012. Additionally, the proposed definition would unite all Autism spectrum disorders - including Asperger's Syndrome and Pervasive Developmental Disorder-under a single heading. The result, say some experts, will be a large drop in those who qualify for the diagnosis. The result of losing an Autism Diagnosis may be a loss of medical benefits, Social Security Disability, support groups and housing. Similar implications are likely for private insurance benefits.
We at Bonny G. Rafel are experienced in helping those with difficult-to-diagnose conditions prove their disability and obtain the benefits they deserve.

By Sara E. Kaplan Esq.

Insurance fraud is a major offense that can carry with it serious repercussions. In order to combat this problem, New Jersey instituted the Insurance Fraud Prevention Act, N.J. Stat. §§ 17:33A-1 to 30. The goal of the act is to prevent insurance fraud in the state of NJ by amongst other things, better fraud detection, developing fraud prevention programs, and requiring repayment for fraudulent insurance benefits received. N.J. Stat. § 17:33A-2.

It is extremely important that when providing information about a claim that you are accurate and honest. According to the act, knowingly making or providing false or misleading statements concerning any fact or thing material to a claim constitutes fraud. N.J. Stat. § 17:33A-4(a). Not only can insurance fraud lead to criminal charges but a person committing insurance fraud can face severe civil penalties as well. If the insurance commissioner has deemed someone to be in violation of the act, the commissioner may seek a civil action, place an administrative penalty on the person, and/or order restitution including but not limited to attorney fees and cost of prosecution. If the commissioner orders an administrative penalty or restitution be paid, a person may request a hearing within 20 days of receipt of the violation. Additionally, if criminal charges are not already brought against you, the commissioner may request that the Attorney General do so.

In addition to facing state imposed penalties and fines, anyone who violates this act may be sued by any insurance company damaged by the fraudulent act. The insurance company can recover compensatory damages that can include surveillance and investigation costs, attorney fees, and any costs related to the lawsuit. If successful the court may award treble damages (three times the amount of the damages) if it is determined that the person has engaged in a pattern of violating the act. N.J. Stat. § 17:33A-7(b). "Pattern" means five or more related violations of the Fraud Act. . Allstate Ins. Co. v. Greenberg, 376 N.J. Super. 623, 640 (Law Div. 2004).

Committing insurance fraud creates a burden not only for the state and insurance companies but also for insureds who are not committing fraudulent acts. Because of the serious nature of insurance fraud it is easy to see why committing it can lead to heavy financial and criminal penalties.

We at Bonny G. Rafel will help you report your disability claim in an honest and effective manner to help you obtain the benefits you deserve.

--By Alexander Schaffel