Courtesy Photo / USAA
A new lawsuit accuses San Antonio-based USAA of using an automated system to "systematically, wrongfully, and arbitrarily" deny or reduce medical claims.
The plaintiffs — both USAA policyholders living in Washington state — maintain USAA Casualty Insurance Co. and USAA General Indemnity Co. denied their payments for medical treatment after they suffered injuries in separate car crashes.
USAA officials had no immediate comment on the suit, which was filed on Nov. 16.
Officials with law firms Tousley Brain Stevens and Franklin D. Azar & Associates, which represent the plaintiffs also were unavailable.
The suit alleges USAA regularly denies medical claims to policyholders because it outsources its adjustment work to an automated system operated by outside company Auto Injury Solutions. The insurer's outsourcing allows it to "systematically, wrongfully, and arbitrarily" deny or cut the amount of claims, according to the petition.
The suit also argues USAA is legally obligated to conduct its own investigation of medical claims before issuing denials. It alleges USAA underwrote thousands of automobile insurance policies in Washington for which it was required under law to offer "payment of 'all reasonable and necessary' medical expenses incurred by a covered person."
In addition to punitive damages, the plaintiffs are asking for financial compensation for medical bills that USAA declined to cover. They also want the court to bar the insurer from continuing to handle its claims using Auto Injury Solutions' computer system.
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