True Crime of Insurance Fraud Video Number 63

Fraud Isn’t Fun AnymoreShow more

Not everyone who commits insurance fraud is a hardened criminal. Not all perpetrators of insurance fraud do so to profit. Some, like the person who is the subject of this story, do it for fun.

Insurance investigators have an unearned reputation for brilliance in investigation. Movies and television paint insurance investigators as tough, highly intelligent, tenacious and almost impossible to fool. The average, contrary to the image created by television, insurance investigator is a 25-year-old graduate of a liberal arts college with little investigative experience.

The training received by insurance investigators, properly so, is directed to a determination of how much and how fast a claim should be paid. Their training in fraud detection is limited by the desire of the insurer to fulfill its obligation to pay claims fairly and promptly.

The Insured did not know about the lack of experience of the average insurance investigator. The Insured believed a person who could succeed at fraud would be brilliant. A successful fraud would be an exciting challenge.

He decided to attempt a fraudulent insurance claim. The Insured wanted the excitement in life he believed was his right to experience.

The broker, based on the excellent quality of the appraisals, had no difficulty insuring the schedule. With his connections in the Surplus Line Market the broker placed insurance with a Swiss Insurance Company he knew to be reinsured 100% by a South African reinsurer. The Swiss insurer bound coverage pending a favorable inspection of the art by an appraiser of its choice.

The Insured emptied his life’s savings and paid the required 10% installment on the $42,000 premium. He knew that the inspector would arrive soon. He did not have the rest of the premium or $1,400,000 in fine arts to show the inspector. It was necessary that the ABC Van and Storage facility be the victim of a burglary before the inspector arrived.

If the investigator had recognized the red flags, she would have interviewed each appraiser. If the appraisers had been interviewed, the falsity of the appraisals would have been discovered immediately and the claim could have been denied for fraud. Reports would have been made to the Fraud Division. The Insured may even have been arrested for Insurance fraud, violation of California Penal Code § 550. Instead, the insured, still bored, has a great deal more money than he could ever have earned working in a movie house.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

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