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March 12, 2018

Draining the Swamp of Insurance Fraud

Summary:

Too many agents compete unethically, offering illegal advice to clients. It's time to start reporting those who commit insurance fraud.

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An agent received the following email from a customer:

“A few people are telling me to save money on car insurance by NOT telling the insurance company who is driving my cars. I have a 23- and 16-year-old – the older one had two accidents, but her premium is reasonable at $2,300 per year for good coverage. These people are telling me that the cars are covered no matter who is driving so don’t tell them about your kids.”

These “people” are allegedly other agents bidding on her personal lines account. I don’t know about you, but I call this email insurance fraud. I suspect most regulators and state attorney generals would concur. For example, here is just one of many fraud statutes from Florida:

817.236 False and fraudulent motor vehicle insurance application:  Any person who, with intent to injure, defraud, or deceive any motor vehicle insurer, including any statutorily created underwriting association or pool of motor vehicle insurers, presents or causes to be presented any written application, or written statement in support thereof, for motor vehicle insurance knowing that the application or statement contains any false, incomplete, or misleading information concerning any fact or matter material to the application commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

See also: How Bad Is Insurance Fraud Really?  

A felony conviction is not an inconsequential thing, nor are the civil penalties and possible incarceration associated with insurance fraud laws. In addition to the fact that insurance fraud is illegal in every state, those that have adopted the NAIC’s Insurance Fraud Prevention Model Act or their own version of that law make reporting of such fraud mandatory. For example, the model act says:

“A person engaged in the business of insurance having knowledge or a reasonable belief that a fraudulent insurance act is being, will be or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.”

The industry and state regulators encourage the reporting of insurance fraud. States with mandatory reporting requirements usually have mechanisms for confidentiality and immunity. If you’re an agent who is aware of this market conduct, have you reported it? If you’re an underwriter or adjuster who is aware of an agent who has engaged in this practice, have you reported it in addition to terminating the agent?

In my blog, I often give “big data” a hard time, but this is an example of how it can supplement underwriting and claims. In a recent blog post, I expressed my distaste when my personal lines carrier sent me an additional auto insurance bill for almost $600 because it apparently learned that my son, who moved out three years ago, still gets his vehicle registration renewal mailed to our house. The presumption, without verification from us, was that he still lives here.

I don’t have a problem with this practice, just with the execution and presumption (from my viewpoint) that I’m dishonest. There is nothing wrong with verifying information provided by an insured or agent, and ‘big data,” without misplaced overreliance, can be a viable tool for that purpose. This is one reason why an agent who engages in the fraudulent behavior described above is being foolhardy. With the growth of data analytics, more and more agents are going to get caught engaging in this type of fraud. And I hope that carriers will have the backbone to report them and get them out of the business.

See also: 3 Major Areas of Opportunity  

This is not a singular or unique tale. I’ve heard it from agents before. Too many agents compete unethically, and some do it illegally. Whether it’s the personal lines agent deliberately underinsuring a home with a “guaranteed replacement cost” provision or the commercial lines agent undervaluing property insured on a blanket basis without a margin clause, the offender needs to be reported and driven out of the insurance industry.

Are you willing to do your part in cleaning up the insurance fraud swamp?

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About the Author

William C. Wilson, Jr., CPCU, ARM, AIM, AAM is the founder of Insurance Commentary.com. He retired in December 2016 from the Independent Insurance Agents & Brokers of America, where he served as associate vice president of education and research.

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