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The Temptation of Fraud
\\nBarry Zalma, Esq., CFE presents videos so you can learn how insurance fraud is perpetrated and what is necessary to deter or defeat insurance fraud. This Video Blog of True Crime Stories of Insurance Fraud with the names and places changed to protect the guilty are all based upon investigations conducted by me and fictionalized to create a learning environment for claims personnel, SIU investigators, insurers, police, and lawyers better understand insurance fraud and weapons that can be used to deter or defeat a fraudulent insurance claim.
\\nWhy Honest People Commit Fraud Without Compunction Studies show that insurance fraud is most often a crime of opportunity rather than serious planning. Honest people, when presenting an insurance claim, often have their moral compass point south rather than true north. A person who would walk a mile to return $5 in extra change received from a waitress will add $5,000 to an insurance claim without a second thought. A lawyer whose word is honored throughout his state will, without compunction, demand payment for \\u201cpain and suffering\\u201d when he was rear-ended even though he resolved all his pain with two aspirin. A judge who has been honored by his peers for his sense of justice and fair play will claim the theft of computers he never owned. A housewife and mother who would beat a child\\u2019s bottom raw for stealing a 50-cent candy bar sees nothing wrong with adding $2,500.00 to a claim for smoke damage in her kitchen. Insurance fraud is easier than working and, often, more profitable. The Fraud Division, California Department of Insurance and the industry have been fighting the rings and professional claimants with vigor. They have ignored, because there is little profit or publicity value in it, the small frauds like the plaintiff in the case I described go unpunished and often succeed.
\\nThe IRC report makes it clear that the professional criminals are 10% of the crime. These professionals should be prosecuted. Only an insurance industry noted for its short-sighted search for instant gratification, would put all its fraud fighting dollars against 10% of the problem and none of its fraud fighting dollars against 90% of the problem. Insurers need a long-term anti-fraud program that goes against the real problem, the opportunist. The honest person must be educated \\u2014 by punishment if required \\u2014 that insurance fraud is the same as theft, burglary or armed robbery. People who build-up a claim or otherwise defraud an insurer are as much a criminal as the person who robs a bank with a gun. Funds that have been cut from insurance claims training must be restored, investigative efforts must be accelerated, claims handlers must be encouraged to refer claims to their Special Investigative Units (SIU) rather than to close as many files as possible.
\\n(c) 2022 Barry Zalma & ClaimSchool, Inc.
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