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Gainsco/mga. A predatory insurer with no concern for rules, regulations, or ethics.

by Raimundo Couret, CLU
(Boynton Beach, FL, USA)

PREDATORY INSURANCE CARRIERS can usually get away with tort while enjoing absolute impunity because:

A: The inmense majority of no-fault insurance claimants do not understand the misleading and complex terminology of their polices and consequently are not trained to do research or to digest the intricate, complex, and interwoven insurance regulations, rules, codes, and case precedents.

B: No one is willing to risk his money paying for legal services that are a lot higher than the amount of the claimed benefit.

C: Lawyers are reluctant to take cases in contingency whenever the Adjuster and the Insurer are conflictive, problematic, or antagonistic to the Claimant.

Therefore, said unethical insurers manage to force their straight jackets on their supposedly naive, pragmatic, or "ignorant" claimants.

However, in my specific Case Gainsco/mga Insurance did not count on my solid insurance education and firm determination to fight to the end for my civil and contractual rights.

I must commend the Florida Chief Financial Officer for the excellent job she does to fight, stop, and prvent insurance fraud...whenever the transgressor is an insurance consumer. Shamefully and regretfully, however, the story is quite different when the violators are, or appear to be, high executives of insurance companies, their claims adjusters, and their sometimes inescrupulous attorneys. Why?

There is a verifiable tendency (in the FDFS) to stop or manipulate investigations when they reach a point where the "sacred cows" may be at risk. Prevarication? Traffic of Influences? Corruption? Unconcern for Dutis, All of the above? None?

A Florida Bar's Investigator threw the towel for Gainsco's Lawyer and he could get off the bar's hook by closing his file. TFB File No. 310-70-540 (11B). The DFS Inspector General appears to be covering the backs of prevaricating specialists and supervisors of the FDFS.(Inspector Generals File No. 10078. Councurrently, this victiized Claimant has been left with the only choice of suing (at the Palm Beach County Circuit Court) in his own representation, taking the risk of incurring in mistakes that an experinced lawyer would never make. But I am still fightig. Case No. 50 2010 CA 003115 XXXX MB. The Complaint to the FDFS is No. 1-610946843.

WHAT INSURERS DO NOT WANT YOU TO KNOW ABOUT P.I.P (Personal Injury Protection) and some attorney may disregard in detriment of their clients:

The Medical Expenses, Loss of Income, and Replacement services do not have to be paid in the very same order listed in the Policy. Although the PIP limit is only $10,000.00 sbject to a $1,000.00 deductible, claims adjusters can manipulate mathematical formulas in the case of still active senior citizens. Let me illustrate the problem using my own experience:

The Wage Loss Benefit (60% of the average wages for the 13 week period preceding the accident) exceeded $9,000.00. Lost wages are not subject to 20 percent co-insurance as medical payments are and MEDICARE takes over as the primaary insurer once PIP benefits are exhausted. (See Medicare's Publication "WHO PAYS FIRS"). Therefore, Mr.Adjuster violated the "sacred" principle of INDEMINITY paying medical bills, so eroding my fully confirmed lost income benefit unequvocally substantiated by bank deposits and clear accounting records.

Therefore, by favoring medical payments Mr. Adjuster would save his Client or Employer $1,800.00 (20% of $9.000.00.

I will not go into other details now, but I will gladly do so if asked by e/mail. I will only add that:

A: After almost a whole year Mr. Adjuster has not even paid the largest portion of my Lost Salary and Wages in spite of:

1. Medical certificates of disability.
2. Wage and Salary Verification Forms duly executed by two ex-emplyers.
3. A Statement Under Oath that was abruptly interrupted as soon as Gainsco's S.I.U. manager discovered that her employer did not have any more pretexts to continue to extort the insured benefits to which I am unequivocally entitled. Insurer refuses to respect my entitledment to recorded version and transcript. Why?

B: A Gainsco's Manager accused me of providing false information to Insurer, and and of forgering Wage and Salary Verification Form, This calumny will eventually become part of a Public Record and will consequently raise serious doubst about my immaculate good name, professional image, honest character, and moral standing before Society.

C: All the malicious violations (by lawyer) can be verified by referring to the Florida and American Bar's Codes of Ethics and Rules of Professional Conduct. In addition the flagrant violations by Gainsco's Officials and by Mr. Adjuster can be corroborated by reading the Code of Ethics and Rules of Professional Conduct for Adjusters. Each fault is clearly depicted in Florida Administrative Code Annotated R.69B-220-201.

D. And as if all of the above described abuses of office were not enogh, Mr. Adjuster has been sharing confidential information with the insurer of the negligent driver who caused my disabling injuries, in spite of the fact that I have not made a BI Claim yet. I have submitted incontestable proofs to the FDFS, but it looks as if Department's Officials may intend to cover it up.

Thank you for reading this Testimony. It may open some eyes.


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