How a Thorough Fraud Investigation Dealt With False Charges of Fraud

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True Crime of Insurance Fraud Video Number 69

Posted on May 9, 2022 by Barry Zalma   

She Did It!

How a Thorough Fraud Investigation Dealt With False Charges of Fraud

Being a good neighbor is hard work. Sometimes it’s impossible. Marsha was not a good neighbor. She would “borrow” things from her neighbors and never return them. Most of her small kitchen appliances arrived because of such loans. Marsha’s neighbors tried to get rid of her. Harry and Louise, who lived next door, looked up the address of the insurance company in their telephone book. They then sat at an old Underwood manual typewriter and wrote a letter to the insurance company that said:

“The claim is a fraud. Marsha’s house was not burglarized. She did not have the items she is claiming stolen.

Marsha, totally innocent and the victim of a crime, was dumbfounded. The lawyer, the SIU investigator and a court reporter, went back to the home of Harry and Louise. They asked Harry and Louise to give testimony under oath to establish the fraud they had reported. They explained to the lawyer why they had told the SIU investigator that they believed Marsha had committed fraud.

On the advice of counsel, the insurance company settled Marsha’s claim promptly.

Every professional claims person must understand that not all obvious frauds are fraud, not all innocent claims are innocent, and it is the obligation of every claims person and SIU investigator to thoroughly investigate every claim with the intent to find that a claimed loss is appropriate and compensable.

ZALMA OPINION

Although SIU investigators are charged with conducting a thorough investigation to defeat insurance fraud, it is also their obligation to establish that an honest claim must be paid. I have personally taken hundreds of examinations under oath at the request of insurers and found, as a result, that a great majority of those claims – like Marsha’s – was determined to be a claim that needed to be paid. Insurers should never accept a charge of fraud without corroborating evidence.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected].

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