Flip Side of Bad Faith Insurance: Gravy Train Claims

June 17th, 2010. By Hunter West

Everybody likes to beat up on insurance companies for denying legitimate claims. And they should be taken to task for such behavior. Americans buy insurance policies in an effort to do the right thing, so as not to leave their families vulnerable in the event they are injured or incapacitated in some way. They pay their premiums faithfully, according to the tenets outlined in the policy. 

When they get hurt, it is their right by law and contract to receive what they have paid for. Shame on any insurer that attempts to pull the rug out from under honest, law-abiding policyholders. Unum, notably, has in the past been accused of grievous examples of bad faith practices—allegations that in some cases have borne out to become fact. 

But it goes the other way too, ya know. There are those who attempt to take the insurance companies to the cleaners. While a wary eye cast for the n’er-do-well should not result in ill treatment of legitimate claimants, you would be amazed at what some people will do to pull a fast one on the insurers, rather than the other way around. 

Take the case of Wanda Podgurski aka Wanda Lee Ann Plager of Manhattan Beach, California. According to an investigation carried out by the California Department of Insurance (CDI), Podgurski took out no fewer than six insurance policies with six different carriers. 

Long-term care polices were purchased from Prudential Group Insurance, Kanawha Insurance, Unum Life Insurance Co. and Metropolitan Insurance Co. 

She didn’t stop there. Podgurski also took out disability income policies with Balboa Insurance Group, and Reassure America Life Insurance Co. 

Podgurski made these acquisitions with tremendous and almost superhuman foresight over a two-year period through 2006. By the end of August that year, it appeared her foreseen injury became reality. Beginning August 30^th Podgurski systematically filed claims with all six insurance providers, as well as a disability claim with her employer, Amtrak. 

According to the CDI investigation Podgurski allegedly claimed she had fallen down a flight of stairs, resulting in an injury to her back, leg and hip and preventing her from working, or caring for herself. Podgurski claimed to be in need of daily care and hired various caregivers to attend to her needs, in her home.  

However a CDI investigation revealed that the woman could, indeed look after herself and care to her own needs in her home. As a result of filing allegedly fraudulent claims for disability benefits through Balboa Insurance Group, Reassure America Life Insurance Co., Prudential Group Insurance, Kanawha Insurance Co., Unum Insurance Co., Metropolitan Life (MetLife) Insurance Co. and Sickness Benefits for Railroad Employees, United States Railroad Retirement Board, Podgurski collected $626,395.14 in disability and long-term care benefits from 2006 through 2009.

However, after three years the gravy train came to an end for Podgurski. She was arrested, bid her caregivers goodbye and was thrown in Los Angeles County Jail on $500,000 bail and charged with 38 felony counts by the San Diego District Attorney’s Office, which is prosecuting the case.

Her arraignment in pending…

It is not clear if her benefit checks will be forwarded to her new address…

Tags: Balboa, Kanawha, Metropolitan Insurance, Prudential, Reassure America Life Insurance, Unum

This was posted on Thursday, June 17th, 2010 at 2:17 pm and is filed under Emerging Issues, Insurance . Feel free to respond, or trackback. Read our comments policy.