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Nearly one out of every five no-fault auto insurance claims closed in the New York City area in 2010 appears to have elements of fraud, according to a new study from the Insurance Research Council (IRC).

And as many as one in three claims appears to be inflated, the group said, after a review of claims from 2007 to 2010 found the percentage of no-fault claims in the New York City area with the appearance of claim abuse rose from 29 percent to 35 percent.

“The apparent amount of fraud and excessive billing by some health care providers in the New York City metropolitan area is truly stunning when compared to the rest of the state,” said Elizabeth Sprinkel, senior vice president of the IRC.

The IRC’s study, New York’s No-Fault System: Preliminary Findings From Closed Auto Injury Claims, found that elements of fraud appeared in 22 percent of all New York City metropolitan area no-fault auto insurance claims — known as personal injury protection (PIP) claims — closed in the fall of 2010. Under New York’s statewide no-fault auto insurance system, PIP is the portion of an auto insurance policy that covers the treatment of injuries to the driver and passengers of the policyholder’s car.

The study also revealed that another 14 percent of the New York City area claims appear to involve either overbilling or excessive utilization of medical services, otherwise known as claims buildup. “While this may not rise to the level of criminal fraud, New York’s honest drivers are essentially subsidizing unscrupulous health care providers when instances occur,” Sprinkel said.

When the IRC looked at PIP claims filed in New York state outside of the New York City metropolitan area, elements of fraud were found in only 4 percent of closed claims. In addition, signs of claim buildup were found in just 4 percent of all upstate PIP claims.

Other key downstate/upstate discrepancies documented in the IRC report include the following:

• In 2010, the typical PIP claims payout for claimants in the New York City area was nearly two times the payout for claimants in the rest of the state.
• 44 percent of New York City area PIP claimants visited four or more health care providers in 2010, whereas only 14 percent of claimants elsewhere in the state did the same.
• In 2010, New York City area claimants were much more likely to seek treatment from chiropractors, physical therapists, and acupuncturists than their upstate counterparts.
• For the majority of claimants, health care providers charged auto insurers far more than the state’s established fee schedule for their services.
• Compared to claimants in the rest of the state, New York City area claimants were significantly more likely to have their health care providers represented by attorneys.

“The preliminary findings from this study confirm that the New York City area is a hotbed for auto insurance fraud and that the problem has grown worse in recent years,” Sprinkel said. “We hope these findings will help policymakers understand the specific behaviors that are driving auto insurance costs so that they canbegin to fashion effective responses to the issue.”

Cleaning up after the blizzard that swept over the Northeast this week has proven to be difficult and dangerous – especially for some residents in New Jersey that ended up in the hospital with serious hand injuries.

A dozen people in northern New Jersey were treated for hand injuries Monday, according to NorthJersey.com, from trying to unclog snowblowers.

One case even required surgery after a man partially amputated two of his fingers, Dr. Joseph Feldman, chairman of the department of emergency medicine at Hackensack University Medical Center in New Jersey said.

“I say to people, ‘Would you put your hand in a blender or under a lawn mower?'” Feldman told the website. “If the answer is no, why would you put your hand in a snowblower?”

Apparently finger amputations and injuries from snowblowers are not that uncommon. According to the latest statistics from the U.S. Consumer Product Safety Commission (CPSC), estimates that each year more than 5,700 emergency room-related visits stem from snow blower accidents, with around 590 of them requiring finger amputations. And since 1992, the CPSC has recorded 19 deaths involving snow blowers.

The CPSC offers these safety tips in order to avoid injury:

– Stop the engine and use a long stick to unclog wet snow and debris from the machine. Do not use your hands to unclog a snow blower

– Always keep hands and feet away from all moving parts

– Never leave the machine running in an enclosed area

– Add fuel to the tank outdoors before starting the machine; don’t add gasoline to a running or hot engine

– If you have an electric-powered snow blower, be aware of where the power cord is at all times

In addition to the hand injuries, Hackensack University Medical Center treated 14 other patients with blizzard-related injuries ranging from falls to chest pains and elevated heart rates.

As snow and ice arrive in New York City, property owners must remember to keep their sidewalks, walkways and parking lots in reasonably safe condition. This helps protect pedestrians from sustaining a fall injury.

Of course, not all property owners maintain their property as prescribed by premises liability law. Sidewalks and parking lot surfaces can crack, rise and fall, become slippery in winter weather and develop holes. Such dangerous conditions can lead to a:
– Broken bone or fractured arm
– Severe sprain or strain
– Cut or bruise
– Concussion or brain injury
– Wrongful death

While most pedestrians are careful about where they are going, some hazards are unavoidable.

What Types of Buildings Must Maintain Safe Sidewalks and Parking Lots?

Whether in the Bronx or Brooklyn, Section 7-210 of the New York City Administrative Code governs the entire City. According to its provisions, the following properties must maintain reasonably safe sidewalks:
– Businesses
– Churches, synagogues, temples, mosques and other houses of worship
– Multifamily dwellings (four or more families)
– Other types of property

Duties include removal of snow and ice; maintenance and upkeep; fixing broken, uneven and cracked pavement; and tending to raised grating or sewers that could cause a pedestrian to trip and fall.

This does not apply, however, to residential properties with one, two or three families, where the properties are owner occupied and not used for business purposes. In those cases, the city would be liable to the person who was injured if the city had notice of the defect in the sidewalk and the person filed the notice of claim within the time limit. New York City also assumes liability for its failure to clear away snow or ice that has accumulated within its crosswalks, also dependent on the proper filing of a notice of claim.

New York parking lots also must be kept in reasonably safe condition. Property owners must not ignore unsafe conditions such as uncleared snow or slippery ice. Once they know of a defective condition, property owners should fix it so that pedestrians can safely walk across the parking lot.

What Should I Do if I Was Injured While on Another Party’s Property?

If you suffer a fall injury while on another person’s premises, seek medical attention. You should also document what happened:
– Take photos using your cell phone or camera, especially when snow or ice is present
– Note whether any witnesses were present and get their contact information
– Note where and when the accident occurred, including information on the property owner and the property owner’s insurance, if possible
– Call the police; then get the number of the police accident report and the name and number of the police officer

STATEN ISLAND, N.Y. – A New Springville woman admittedly was drunk when she slipped and fell outside a Great Kills bar three years ago.

But in a lawsuit, Ryan O’Leary contends it was KJ’s Ale House’s fault, not hers, because she allegedly was served alcohol despite being underage.

Ms. O’Leary, whose Facebook page shows her smiling and holding a pair of pint glasses containing stirrers and an unspecified liquid was 20 when the incident occurred on Jan. 10, 2008. She is now 23.

The legal drinking age in New York is 21.

Ms. O’Leary seeks unspecified monetary damages in the action, recently filed against the bar and the property owner, Gentile Family LLC, in state Supreme Court, St. George.

Her mother, Kathy O’Leary, also seeks unspecified compensation for her daughter’s medical bills and loss of her services.

The incident occurred around 11:45 p.m. outside the Nelson Avenue watering hole.

According to court papers, Ms. O’Leary had been drinking at the bar and was in “an impaired or intoxicated condition” when she left.

Once outside, she allegedly slipped and fell on a defective sidewalk or curb.

Ms. O’Leary and her mother maintain the bar was at fault for “unlawfully” serving her alcohol which resulted in her drunkenness.

Bar personnel gave Ms. O’Leary drinks, despite having “knowledge or reasonable cause” to believe she was under 21, court papers charge, without further elaboration.

The property owner also was liable for not properly maintaining the sidewalk, the O’Learys contend.

Court papers don’t specify Ms. O’Leary’s injuries.

Her lawyer, Frank Dito, did not return a telephone call Thursday seeking comment.

Attempts to reach the O’Learys by phone last week were unsuccessful.

Alphonse Gentile, the principal of Gentile LLC, the property owner, said Thursday he had not received the suit papers and knew nothing of the incident.

Messages left Thursday for KJ’s owner were not immediately returned.

NEW YORK – Leticia Moratal and Jacqueline Aguirre spoke out together for the first time Tuesday, Jan 18 at the Bayanihan Center in Queens, to share their plight and discuss how their dreams of a better life in America were dashed when they became alleged victims of labor trafficking.

While their cases are different, both women have sued their former employers for alleged violations of Trafficking Victims Protection Reauthorization Act (TVPRA), Fair Labor Standards Act (FLSA), New York Labor Law and common law.

In between tears, Moratal and Aguirre recounted how they found themselves in these difficult situations.

Moratal arrived in New York in 2001 on a B-1 visa to work as a babysitter for a Filipino family, and was promised a monthly salary of $800. She was later taken to Florida to work in the home of the couple’s daughter. This was when her nightmare began.

For close to 10 years, Moratal said she worked long hours as a babysitter to the grandchild of a Filipino couple. She also cooked, cleaned, did the laundry and yard work for the household, yet she claims she was never paid by the family.

Moratal said she was subjected to cruel treatment and psychological abuse, being called slave and made to sleep in the stock room or the baby’s bedroom floor.

“I used to cry myself to sleep every night because of my situation. They took all my human rights. They even changed my name to Baba. One day, the girl I was taking care of returned from school with her friends. She introduced me to her friends as ‘Baba, my slave’. All I can do then was to pray,” Moratal recalled.

In 2009, Moratal was sent back to live with the elder couple in Jamaica, New York. Her fate changed when her aunt Maria Garri traced where she lived. Last month, Moratal escaped from her employer’s home.

Through Attorney Felix Vinluan, an immigration lawyer and a human rights advocate, Moratal filed a case against the family she worked for on December 28, 2010. The case was filed at the New York Eastern District Court in Brooklyn.

Through the lawsuit, Moratal is demanding damages from her employer for human trafficking, involuntary servitude, unlawful conduct, fraudulent inducement, negligent misrepresentation, emotional distress, wage violations, unjust enrichment and conspiracy.

Vinluan said he is also filing a U-Visa for Moratal as a victim of human trafficking so she could legalize her status and work in New York.

Jacqueline Aguirre, on the other hand, took an accountancy position in 2001 at a nurse staffing agency in Floral Park, New York, upon verbal agreement with the owners that the company would sponsor her green card and pay her $19 an hour for a 40-hour work week.

Aguirre said she was misled to believe that her sponsor had the financial capability to sponsor her green card. She added that the owners knew that the company was not earning sufficient net income to cover for the offered wage rate and did not have the financial capability to pay Aguirre’s offered wage. As such, her application for green card was denied and she is currently subject to removal proceedings by the US Department of Homeland Security for overstaying.

Moratal is seeking overdue compensation of back-wages totaling up to $250,000 while Aguirre seeks back-wages worth at least $100,000, as well as for damages related to their abuse and maltreatment.

Community Support

The National Alliance for Filipino Concerns (NAFCON), a national alliance committed to protecting the rights and welfare of Filipinos in the U.S., is standing behind the pursuit of justice for Moratal and Aguirre.

“We would like to say that Ms. Moratal and Ms. Aguirre have inspired us at NAFCON to recommit ourselves in the basic human rights of our community members and to further strive to protect their rights and welfare now that they are in this predicament,” Rusty Fabunan, NAFCON’s representative said.

“With 4,500 Filipinos in average leaving the country everyday, these injustices happen a lot among our kababayans in different parts of the world, but only a few have the courage to speak out. We are glad and inspired that these two strong Filipinas who have withstood these abuses for a long time are now willing to step up and stand up for their rights,” said Lorena Sanchez of the KABALIKAT Domestic Workers’ Support Network, a member organization of NAFCON based in New York.

Moratal and Aguirre are being represented by Atty. Felix Vinluan of the Filipino-American Foundation for Immigration and Employment Advocacy, Inc. (Fil-Am Foundation).

“Leticia and Jacqueline are heroes for stepping forward courageously to fight common injustices inflicted upon foreign workers in this country—labor trafficking and modern-day slavery,” Vinluan said. “It is NAFCON’s hope that their example helps other trafficking victims living in fear to come forward and, with community support, fight for justice.”

For Moratal, it is all about getting her story out there so that nobody becomes a victim.

“I don’t want this to happen to anybody who is coming here to America, especially among Filipinos. It is unacceptable,” she said.

(www.asianjournal.com)

(NYNJ Jan 21-27, 2011 Sec A pg. 1)