Mercury's Special Investigations Unit Shines a Light on Unexpected Criminals
LOS ANGELES, May 19, 2016 /PRNewswire/ -- Insurance fraud isn't a victimless crime. The second most costly white collar crime in America behind tax evasion, it accounts for at least 10 percent of property and casualty claims, and costs citizens billions of dollars each year. To protect customers, the Mercury Insurance Special Investigations Unit (SIU) completed 1,792 investigations during 2015 in California alone, resulting in $5,908,794 in claims payouts being avoided.
"People would likely be surprised to learn that some of their family members, closest friends and neighbors have committed insurance fraud," said Dan Bales, national director of special investigations for Mercury, which established one of the country's first SIUs in 1978. "Our SIU team has seen it all and we continue to uncover new ways people try to cheat the system. Preventing fraudulent claims and undeserved payouts helps Mercury keep its customers' premiums among the lowest in the insurance industry, so this is definitely not a victimless crime. We all pay for insurance fraud."
Mercury often shares the ways in which criminals try to defraud the system … but fail. The following claims are three examples of con artists trying to pull one over on all of us.
Claim #1: "I've Fallen and I Can't Get Up"
The claimant had just finished breakfast at a restaurant with a friend. As his friend went to pay the bill, the claimant headed towards the exit when, suddenly, he stumbled to the ground. He stated that his shirt had gotten caught on the walker of a patron who was waiting to be seated and, as he tried to free his shirt, somehow his foot got caught, making him fall to the floor. His friend and a restaurant employee helped him to a chair, where he complained of feeling pain in his left foot and ankle, so his friend took him to the doctor. The restaurant's owner filed a claim with his business insurance agent, who reported the loss to Mercury.
Several witnesses who were in the vicinity during the alleged incident told the owner a different story, however, suggesting the man was running a scam and that the owner should check his surveillance video.
Mercury's SIU was brought in to investigate the incident and the surveillance footage clearly shows the claimant falling to the ground on his own accord – there were no obstructions in his way. Mercury denied the claim after viewing the footage … and never heard from the claimant again.
Claim #2: Life in the Lap of Luxury
Mercury's insured was making a left turn and failed to yield, striking the claimant's vehicle as it was passing through the intersection. The collision caused a significant impact, totaling both vehicles in the process. The claimant and his son were in the vehicle – a 2012 Audi R8, which is worth more than the average American makes annually – at the time, and Mercury handled the property damages by paying its insured's policy limits. The claimant also pursued an injury claim and sent in a package of medical bills that included an urgent care visit, chiropractic care and $11,100 in massage bills for his son and him.
The insurance adjuster tried to confirm if the massages had been recommended by a doctor, but attempts to contact the massage therapist were in vain – the number listed on the bills was invalid. A visit to the listed address also uncovered that no such apartment existed. Mercury's SIU stepped in to learn more.
The SIU insurance fraud investigator assigned to the claim successfully located the massage therapist, who confirmed she had seen the claimant and his son. She informed the investigator, however, that there were many discrepancies in the claimant's story.
First and foremost, the therapist hadn't produced any of the bills that were submitted to Mercury. Next, she recalled six or seven visits, not the 37 for which they had submitted bills. She also noted that her billable hourly rate was $50, not the $150 denoted on the bills. And, finally, she informed the investigator that the claimant told her Mercury had given him approval to use her services, but he never gave her a medical prescription or other documentation to show that massage was a necessary treatment due to injury.
Criminal charges have been filed and there's a warrant out for the claimant's arrest.
Claim #3: Burn, Baby, Burn
Mercury's insureds reported their vehicle stolen a few months after they purchased it. Thirty minutes after they called 911, the car was found engulfed in flames. The insureds' cell phone records showed that they were both home when the car was traveling to its final destination, so Mercury paid their claim.
Further investigation of cell and home phone use showed the insureds in communication with their children before and after the car went missing. It's not unusual for parents to talk to their children frequently, however, it is unusual that, during those phone calls, their children's cell phone signals pinged in the exact location where the charred car was discovered. Even more curious was the fact that the vehicle had an electronic key that recorded ignition starts, and when law enforcement downloaded that information they discovered the key was used to start the car at the time it was stolen. The insureds had the key in their possession, which means to believe their story you would have to believe a thief stole the car and returned to the home to return the key to the owners … not very likely.
The insureds were convicted of three counts of felony insurance fraud and they now face up to seven years jail time.
The public can do its part to help lower insurance costs by reporting suspicious activity to the National Insurance Crime Bureau.
ABOUT MERCURY INSURANCE
Mercury Insurance (MCY) is a multiple-line insurance organization predominantly offering personal automobile, homeowners and commercial insurance through a network of independent agents in Arizona, California, Florida, Georgia, Illinois, Nevada, New Jersey, New York, Oklahoma, Texas and Virginia. Since 1962, Mercury has specialized in offering quality insurance at affordable prices. For more information visit www.mercuryinsurance.com or Facebook.com/MercuryInsurance and follow the company on Twitter.
ABOUT THE MERCURY SPECIAL INVESTIGATIONS UNIT
Whether it's a staged car crash, home arson or exaggerated injuries and suspect medical billing, criminals are creating new ways to cheat their insurance company, necessitating the existence of groups like the Mercury SIU – the CSI of the insurance industry.
Mercury's SIU was founded 36 years ago, becoming one of the first companies to create an investigative department to combat insurance fraud. Since its inception, the SIU, which employs more than 50 seasoned investigators nationwide, has exposed thousands of fraudulent auto, home and medical claims, saving policyholders millions of dollars annually. The SIU mission: prevent phony payouts, which helps maintain low premiums for Mercury customers.
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SOURCE Mercury Insurance
Last Updated: February 28, 2023