Kevin Rainbolt, Western Regional SIU Manager for AIG, made his talk on dealing with fraud entertaining as well as being informative.
John Stackhouse, of EFI Global, wins a special prize for having been paying attention and reading his newsletter.
Bob Tucknott and Frances Hewitt, of Tucknott Electric Company, get a laugh from the crowd over Bob's "Pimp Hat".
Congratulations to 50/50 winner, CCCA first-timer Matt Mumford, of Safety Environmetnal Control fo California, Inc.
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Big world of fraud out there
"No lie, no fraud." That was the leading message from AIG Western Regional SIU Manager, Kevin Rainbolt, at the April 19, 2007 luncheon meeting of the Central Coast Claims Association in San Jose.
"The act of receiving the money is not the crime," he stated. "It's the lie about it."
Insurance carriers in the state of California have a statutory requirement to maintain a "Special Investigations Unit (SIU)" department. Not all states have such a requirement, making the fight against fraud on a national level even more difficult.
Getting any kind of real prosecution, even on "slam dunk" cases can be a very difficult proposition, according to Mr. Rainbolt. To the insurance industry, he stated, "fraud" is the "five letter 'F' word".
From very organized fraud rings, like those recently busted in Southern California, to insurance agents back-dating policies for coverage, insurance fraud is treated as a "white-collar" and/or "victimless" crime.
Rainbolt described one case in which a "$750,000 fraudster" go all of 30 days in county jail, which ultimately was served at home. "they did have to pay restitution," he added.
He teaches staff to begin interviews with "please tell what happened". "Once they've lied to you, they've committed fraud," he explained.
"People that manage the risk don't really speak the language of fraud investigations. Self-insured companies often don't have a clue about fraud," he said, explaining the difficulties facing departments such as his.
"Malingering" is the most common and costly fraud, typically, he said. Exagerated and extended Workers' Comp. cases constitute a big part of that.
Mr. Rainbolt described on auto fraud ring in Southern California that included a towing company, insurance agent, attorneys and doctors. The tow truck driver would approach an uninsured driver of a damaged vehicle and hand them a card for the agent, stating that he could back-date a policy for them. Chiropractic bills, and attorney fees would all be covered.
It's an uphill battle, bu the thing we all need to realize, he said, is that ultimately it's the consumer who pays for these fraudulent claims, so we're all the real victims.
Thank You to ALL our April Meeting
Door Prize Sponsors
CRDN
Borton, Petrini & Conron
Tucknott Electric Company
Marriott Execustay Ins. Housing Solutions
EFI Global
FRSTeam
Restoration Management Company |
U.S. map illustrating the degree to which fraud investigations and prosecutions are mandated around the nation.
CCCA President Denise Garcia, of Marriott Execustay, announced upcoming events, including the Golf Tournament June 1, the Claims Conference in Sept., and the Bowling Tournament in October.
Golf Tournament Chair, Deanie Pearson, offered up details about the June 1st event, to be held at Coyote Creek Golf Course in San Jose.
Frances Hewitt wins a Santana Row shopping spree.
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