OFFICE OF THE INSURANCE COMMISSIONER SPECIAL INVESTIGATIONS UNIT MAY 2008 NEWSLETTER
Welcome to the first Office of the Insurance Commissioner – Special Investigations Unit (OIC – SIU) newsletter. This newsletter will be sent out three times a year summarizing the accomplishments and activities of the OIC – SIU. The OIC – SIU’s mission is to identify, target, investigate, disrupt, and dismantle criminal organizations and individuals engaged in fraud schemes that target the insurance industry. While our primary focus is organized insurance fraud, the OIC – SIU also looks at high-dollar, single-claimant cases. When submitting a referral please refer to the requirements below for case review and acceptance. The SIU holds weekly meetings at 9 AM on Tuesdays to review referrals, discuss trends, and address other timely issues. Meetings are at our office located at 1520 Irving Street SW, Suite C in Tumwater 98512. Representatives from insurance and health organizations are welcome to attend. To be added to the agenda or for further details please contact Katherine Ward at 360-586-2566 or katherinew@oic.wa.gov.
REFERRALS: When referring claims through ISO or NAIC the following information is beneficial in helping the OIC – SIU determine if your claim will be investigated: Full name of party(ies) Date(s) of birth Social Security number(s) Address(es) (including city and zip code) Telephone number(s) Amount(s) paid out Vehicle(s) (VIN, license number, year, make, and model) Attorney (if applicable) Provider (if applicable) Status of claim(s) Investigative expenses
CURRENT STATS:
(Cases were taken starting January 1, 2007)
46 cases opened 23 active / 15 closed 8 referred for prosecution 2 adjudicated / 2 deferment / 3 pending / 1 declined Active case breakdown is as follows: Auto Body Auto Glass Provider Fraud Bodily Injury Catastrophe Disability Disability/Forgery Medical Billing Medical Provider Personal Property Staged Collision TOTALS 1 1 4 1 1 1 1 4 5 4 23
FRAUD CHARGED / CAUGHT IN THE ACT / NAUGHTY, NAUGHTY, NAUGHTY: Case One On June 5, 2006 in King County, Tamra Wilson was driving a Dodge pickup and backed her vehicle into a Ford Mustang, causing $2,000 worth of damage to the Mustang. Wilson attempted to leave the scene of the collision, but was detained by witnesses. At the time of the incident Wilson did not have vehicle insurance on her Dodge pickup. In an attempt to cover the costs for repairs to the Mustang, Wilson attempted to file a fraudulent claim by using her Government Employees Insurance Company (GEICO) insurance policy that only provided insurance coverage on her BMW. Wilson was charged April 18, 2007, with one charge of filing a false insurance claim (RCW 48.30.230(1); one count of Theft 2 (9A.56.040); and one count of criminal attempt (9A.28.020). Wilson pled guilty August 16, 2007, to all counts. Her penalties included one day in jail, 232 hours of community service, 24 months probation, and restitution of $2,762. Case Two On April 23, 2006, Brian Green (Madison Motors) reported to the Auburn Police Department that his 1995 Ford Flatbed was stolen from his place of employment. On June 6, 2006, Green submitted a $47,800 claim to Farmers Insurance Company for the stolen flatbed and a 2000 Ford Ranger that he then claimed was on the flatbed truck. Green’s Proof of Loss to Farmers states he purchased the Ford pickup on April 6, 2006. The vender that sold the pickup showed a sale date of April 27, 2006, five days after the alleged theft. Neither vehicle was recovered. Green was charged July 23, 2007, with one count of filing a false insurance claim (RCW 48.30.230(1)) and one count of criminal attempt (9A.28.020). Green pled guilty to misdemeanor insurance fraud. Green’s penalties included one day in jail, forfeiture of his business license to sell used vehicles, and restitution to Farmers for investigative expenses in the amount of $2,000.
FRAUD CHARGED / CAUGHT IN THE ACT / NAUGHTY, NAUGHTY, NAUGHTY (cont’d): Case Three While traveling to California with a U-haul trailer, Juli-Anna Rowe claimed that her vehicle and trailer were stolen. Rowe claimed there was $89,000 worth of personal property in the trailer and submitted altered receipts for her replacement cost coverage. The cost, by State Farm, to investigate the claim was estimated at $12,893.04. Rowe’s case was placed in deferment for three years for adjudication and restitution by the Snohomish County prosecutor. Case Four Frank Carter filed a false claim with Encompass Insurance on April 26, 2007, stating that his vehicle was involved in a hit-and-run in Lynnwood. Carter’s vehicle had actually been involved in a collision in Las Vegas on March 29, 2007, while being driven by Frank Costa. Costa later admitted he was driving, but was completely unaware of the insurance claim filed by Carter. The investigation uncovered a DVD showing the vehicle in question parked with damage at the Las Vegas auto show and a cell-phone picture taken during the same time frame. Once confronted with the evidence, Carter agreed to repay Encompass, but failed to do so by the agreed date of December 15, 2007. Only when confronted with the prospect of prosecution by the OIC - SIU, did Carter finally send payment on December 31, 2007. Carter’s case was placed in deferment for three years for adjudication and restitution by the Snohomish County prosecutor.
The next Newsletter is scheduled for September 2, 2008. If you know anyone who would like to be added to the mailing list please have them contact Kristi Barbieri at kristib@oic.wa.gov.