Sep 20
Insider Insurance Fraud
Insurance fraud is apparently an epidemic in this country and very much in the news these days. Typically though, the insurance fraud cases we read about are phony auto repair claims where the shop owner is in collusion, medical claims where the doctor or clinic is in collusion, or claims from individuals seeking restitution for personal property that was not in fact stolen or destroyed.
An interesting approach to the insurance fraud industry was reported in Florida following the spate of nasty hurricanes that have passed through there over the last couple of years. Two licensed insurance adjusters were engaged in defrauding the insurance companies that they were representing. Two employees of Coast to Coast Public Adjusters allegedly submitted approximately 75 forged contractor agreements, resulting in an overpayment by Citizens Insurance of approximately $314,596.54. Detectives said an additional 29 such documents were submitted to the Tower Hill Group resulting in a loss of approximately $125,281.81.
The payoff from the forged contractor agreements that were submitted resulted in an additional 20 percent of the estimated claim for overhead and profit. The fraudulent contractor agreements stemmed from real claims for water pipe damage. Each defendant was charged with 104 counts of insurance fraud (third degree), 104 counts of grand theft (third degree) and one count of organized scheme to defraud (first degree) each. According to the news wire, bail was expected to top one million dollars. The property insurance situation in Florida is a mess; aggravating it through insider fraud is not going to be well received.
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September 25th, 2007 at 2:34 am
It is not just insurance companies which need to worry about this. So much information is now available about customers, that almost any type of business which inadvertently hires an unscrupulous employee can lead to serious trouble with insider fraud cases. The fact that the insurance industry deals with such voluminous client information (and often such high amounts of money) makes it even more susceptible!
Jerry
http://www.leads4insurance.com