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Wednesday, 21 December 2011 21:09

Texas DOI Investigating ANPAC Insurance for Possible Fraudulent Document in Shop Claim

John Borek, General Manager of Autocraft Bodywerks in Austin, Texas, has filed a complaint with the Texas Department of Insurance against American National Property and Casualty Company (ANPAC) and a claims services company, American Claims Services, alleging that they “knowingly used a fraudulent document to justify their short-pay” of a claim.

Borek said his shop submitted supplements on the claim to ANPAC through American Claims Service, which denied payment for color sand and buff, sending the shop a document it said was from Audatex showing that procedure as included in 2-stage refinish formula.

Borek said he filed an inquiry with the Database Enhancement Gateway (DEG), and Audatex, after searching the shop’s “Database Reference Manuals” back to 1993. Borek said he had never seen the supposed Audatex document before being presented with it from ANPAC. The DEG stated that the document is “most certainly not from ADP/Audatex.” (The actual Audatex manual shows color sand and buff as a not-included item.)

“Color sand and buff has been a pet-peeve of mine since 1998, and I know it’s not included in any paint time,” Borek said. “But how many shops are being sent incorrect information about things like this and not knowing any better?”

The Texas Department of Insurance is now investigating ANPAC for using a supposedly fraudulent document. According to Borek, ANPAC has said they will pay the supplement now, but he has not seen any payment since reporting the findings to the DEG.

In filing his complaint with the Texas DOI Property and Casualty Complaint Department, Borek wrote: “We believe that based on this document, ANPAC/American Claim Service is knowingly using a fraudulent document to justify their short pay to limit the price paid for repairs to [the] automobile.  By not performing these necessary operations, it will result in an incomplete repair.  I have spoken today with the field appraiser assigned to this file and he confirmed that he put the needed repair operations on the original estimate (see Exhibit G-3) although a document generated from ANPAC/American Claim Service shows a zero by all these operations.

“As resolution to this complaint, please take the necessary enforcement action against ANPAC/American Claim Service for what are appears to be deceptive trade practices.

“I have attached the following exhibits and contact numbers for your review:
“Exhibit A: Request to the database enhancement gateway to verify validity of document ANPAC/American Claim Service provided.
“Exhibit B: Document from ANPAC/American Claim Service stating they are denying payment for needed operations due to document they claim came from Audatex.
“Exhibit C: Document ANPAC /American Claim Service provided that misrepresents material facts.
“Exhibit D: Email from Audatex Manager, Robert Sandkaut, stating Exhibit C is not from Audatex.
“Exhibit E: Correct database reference manual  from Audatex.
“Exhibit F: Email from the database enhancement gateway stating that Audatex will be contacting American Claims Service and sending them a current copy of the database reference manual.
“Exhibit G-1 through G-6:  Last supplement from ANPAC/American Claims Service.
“Exhibit G-3: Supplements, 4 from ANPAC/American Claims Service listing the needed operations as zero on their estimate and that they are included in two stage refinish which is a material misrepresentation.”

You can view the full text of these documents by clicking HERE.

Borek says he has spoken to the claim representative, the field appraiser, and the Texas Field Supervisor for ANPAC about this incident. “I have attempted to contact American Claim Service who will not take or return my phone calls.”

“It’s just amazing that these insurance companies will do this,” said Borek.

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