How Mercury Insurance's Special Investigations Unit Spot Fraudulent Claims
Mercury insurance protects policyholders and keeps rates low by being one step ahead of fraudsters
LOS ANGELES, July 22, 2022 /PRNewswire/ -- Fraudulent crimes against insurance companies may seem victimless, as the ones being scammed are large organizations with seemingly a lot of money behind them. However, it really is the public that is being taken advantage of in these situations.
"People might think that unless their personal information has been stolen and used for illegal activity, someone trying to scam an insurance company doesn't directly affect them," said Pete Galassi, Mercury Insurance Special Investigations Unit (SIU) Manager. "That couldn't be further from the truth. Fraudulent insurance claims cost policyholders $700 more each year. Mercury's SIU team is always on the lookout for criminals trying to scam their way into our wallets by filing phony claims. Being one step ahead of criminals is what helps Mercury keep policyholder premiums some of the lowest in the industry."
Insurance Fraud Examples from Mercury's Special Investigations Unit
The following are examples in which Mercury has thwarted fraudsters looking for a big payday:
Claim #1: Repeat Offender
A loss was reported when an insured's vehicle made a left turn and struck the claimant's vehicle which caused it to collide into another vehicle. The claimant was to have been in that second vehicle and sought representation with an attorney in pursuit of a bodily injury claim.
A Mercury branch supervisor noted the time and date stamp on the x-ray films submitted on behalf of the claimant were taken prior to the time of loss. There was a match in the system reflecting a prior motorcycle collision and the same attorney as the present claim represented the claimant in a prior matter. By obtaining the claimant's in-person recorded interview and visiting the medical clinic from which the records were to have been generated, the investigator confirmed that the x-ray reports were forged. The investigator met with the insured's attorney who, without being presented with full evidence, elected to withdraw from the case.
The Los Angeles District attorney's office requested an accounting of the costs of the claim including the fees paid to the forensic expert and a listing of the time spent on the investigation. A letter was sent to the handling prosecutor identifying expenses totaling several thousand dollars.
"Fraudster stopped in his tracks and innocent policyholders were protected," Galassi said.
Claim #2: Department of Injustice
A claim was filed for $2,200 worth of personal property being stolen from their vehicle. When processing the claim, multiple red flags popped up. An investigation revealed that the claimant had two previous National Insurance Crime Bureau (NICB) referrals for a burned vehicle and a theft of personal property claim with different insurance companies, as well as a third investigation for another burned vehicle.
During the SIU investigation, nine receipts and invoices submitted from an online retailer had been falsified and manipulated. The invoice numbers submitted were correct, but the items purchased on those invoices had been fabricated. Upon closer review the tax amounts and font on the invoices were also different. The claimant, an employee with the Department of Justice for the State of California, used their government email to send fabricated invoices to their personal account, which was ultimately forwarded to the claims adjuster. The claimant was interviewed by SIU and when presented with the evidence discovered during the investigation, the claimant admitted that the invoices were falsified to gain policy benefits.
SIU reported the fraudulent claim to the Department of Insurance which led to another investigation. The combined investigations of both Mercury and the Department of Insurance led to a conviction for presenting a fraudulent insurance claim.
If you suspect you may have been a victim of insurance fraud, contact the National Insurance Crime Bureau.
About Mercury Insurance
Mercury Insurance (NYSE: MCY) is a multiple-line insurance carrier predominantly offering personal auto, homeowners, renters and commercial insurance through a network of independent agents in Arizona, California, Illinois, Georgia, Nevada, New Jersey, New York, Oklahoma, Texas and Virginia, as well as auto insurance in Florida. Mercury writes other lines of insurance in various states, including business owners and business auto, landlord, home-sharing, ride-hailing and mechanical protection insurance.
Since 1962, Mercury has provided customers with tremendous value for their insurance dollar by pairing ultracompetitive rates with excellent customer service. Mercury has earned "A" ratings from A.M. Best and Fitch, as well as ranking highest in the J.D. Power 2021 U.S. Insurance Digital Experience StudySM and four consecutive "Best Auto Insurance Company" awards from Insure.com. For more information visit MercuryInsurance.com or follow the company on Twitter or Facebook.
SOURCE Mercury Insurance
Last Updated: 3/14/23