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Zalma on Insurance
Help! I’ve Fallen & Broken My Glasses. I Don't Need Your Stinkin' License! Miscarriage Manipulation for Money US Supreme Court Restrains Punitive Damages Barry Zalma, CFE, is an insurance coverage attorney. He is the founder of Barry Zalma, Inc., a California law firm whose practice emphasizes the representation of insurers and those in the business of insurance. Mr. Zalma is the author of Insurance Claims: A Comprehensive Guide, published by Specialty Technical Publishers, Vancouver, BC at http://www.stpub.com The Truth, The Whole Truth & Nothing But The Truth, Property Claims 2nd Edition and Liability Claims and all course books used by ClaimSchool, Inc. in its training programs. He is also the author of three books published by Thomas Investigative Publishing, and numerous articles for insurance trade publications and law journals. Mr. Zalma writes the monthly Zalma's Insurance Fraud Letter which is available, FREE, from ClaimSchool, Inc. and over the internet at http://www.zalma.com Specialty Technical Publishers has published "Mold: A Comprehensive Claims Guide" by Culver City lawyer Barry Zalma. The book is the only comprehensive guide to cover all issues relating to claims of damage by mold or fungal infestations. It is an essential tool for every person who owns real property, manages real property, for all risk managers, realtors, property inspection companies, insurance agents and brokers, insurance claims people, and lawyers who represent property owners or insurers. It is available at http://www.stpub.com or by calling 1800-251-0381 |
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A
Christmas Fable of Fraud Raymond Alexander had no religion. He cared
only for himself and the money he could take from goodhearted people. He loved the Christmas season. The marks were in such a kind and giving mood it
wasn't even work to take their money. The Christmas before last Raymond stumbled on
insurance fraud as a lucrative means of making quick, easy money. Raymond made a good living playing bunco schemes
about town. He would work the money switch with old folks, the dip, and
every possible scam invented to take money from honest people who had a
little larceny in their hearts. Because he was good at what he did Raymond lived
well. He leased a three-bedroom apartment in the best part of town,
drove a BMW convertible when he wasn't working and purchased all of his
suits from a custom tailor. He ate at gourmet restaurants and collected
an eclectic assortment of popular art dishes and Lladro figurines. Raymond, because he loved his collection, insured
his home with the best and most expensive insurer he could find. He had
his figurines appraised and scheduled on his policy so there was no
dispute if he had to make a claim. Raymond called his insurance agent and reported
his claim. To his surprise his insurer telephoned him and asked what was
lost. No one came to his home. No one asked to come to his home to
investigate. They merely called on the telephone and asked for the
number of the police report so the insurer could obtain it. Such unthinking trust deserved to be made a victim
of Raymond's wiles. He, the consummate professional, could not resist
the temptation. He told the person on the telephone that he was not sure
what was taken and that he had only reported that which was obvious on
first inspection to the police. As a bunco artist of the first order
what came next was simple - the police officer had left him with a sheet
of paper to list any items that he later discovered were missing.
Raymond sat at his oak and leather antique partner's desk and prepared
his supplemental police report. On the report he listed one out of every
four items on the insurance schedule. Then he added three Armani suits,
two pairs of Ecco dress boots, a pair of Bruno Magli sport shoes, two
pairs of gold cuff-links, and a simple Omega wrist watch. He was not
greedy. He sent the list to the detective and a copy to
the adjuster who spoke with him on the telephone. Raymond expected he
would need to haggle and would be forced to document each item to the
insurance company. Much to his surprise, two weeks later Raymond
received a nice letter from his insurer. It advised him that the
adjuster had calculated his loss, deducted $500 (his deductible) and
could only count the jewelry to $1,000 because of a special limitation
in the policy. The adjuster FYI Expressed her regret in not being
able to pay him for everything he lost and hoped the enclosed check for
$35,650 would be satisfactory. Since Raymond had only lost $375.50 worth of goods
the check was quite satisfactory and he spent the Christmas season in a
comfortable resort in Bermuda. When Raymond returned from Bermuda he took the
things he had reported stolen to high-end swap meet in Long Island, New
York. He traded one Lladro for another, one plate for another and bought
some new jewelry. He called his appraiser, who updated the appraisal
on his schedule by taking out the items stolen and replacing them with
the new items he had acquired. His policy was renewed and the schedule
increased and changed to meet the new items with a value of more than
$150,000.00. He wanted the mark to know he was taken and to be
too embarrassed to do anything about it. Raymond looked on his insurance company as another
mark. He did not want to collect $150,000 from them, only It was time to have another loss and claim. A fire
was out of the question, too messy. Robbery was dangerous and the person
hired to fake a robbery might forget he was not supposed to really rob
Raymond. A fake burglary might be worse because the police got testy
about false police reports. He might make a mistake and they would learn
the burglary was not real. Raymond Alexander was successful at his chosen
criminal profession because he paid attention to detail. He read his
insurance policy. Part of that policy was a Personal Articles Floater
that insured for all risks of physical loss. It had very few exclusions.
It covered, for instance, the Lladros and the plates against loss (with
no explanation) or even breakage from any cause, including an
earthquake. Raymond knew he could not cause an earthquake but
he had no problem losing his art. He removed from his home, two or three
items at a time, for several weeks. Figurines and plates valued by his
appraiser at $51,632.00 were stored at a Public Storage unit. The number
was nice, odd and with no zeros except the cents. On November 15 Raymond telephoned his insurance
agent to report that he returned home from a weekend trip to Connecticut
to his apartment in Boston and found selected parts of his collection
missing. There was no evidence of a break-in to his house and all he
could explain to the agent was that the items had disappeared,
mysteriously from his home. The alarm had been set and was operating
perfectly. It detected no intruders but the items were gone. Again, Raymond was contacted by an adjuster by
telephone. He learned that she was in Phoenix, Arizona and never left
her desk to deal with claims. She asked for, and Raymond gladly gave, a
recorded statement concerning the events and the items claimed stolen.
She kept him on the telephone for almost an hour taking from Raymond as
much detail as he could possibly remember about each item. He went to his insurance broker, after he
"replaced" all the missing goods and obtained an identical
policy from another insurer for a smaller premium. They were willing to
take a chance that lightning would not strike the same place three times
in a row. Raymond enjoyed his insurance company money and
did less of his normal scams. Taking an old woman's savings through a
convoluted scheme when he could wrest money from an insurer with such
ease seemed wrong. The payments also allowed him to add to his
collection with no new spending. Raymond was a happy man. His BMW had become boring
to him. The state made him insure it so he had the best insurance money
could buy from the New York Auto Insurance Specialists. He drove the vehicle to Boston Harbor where it was
shipped to an acquaintance with whom he had done a sting in Hartford who
now lived in Belize. For a 15% commission the BMW was sold to a General
in the Belize army for its high Blue Book value. Raymond then reported
to the Boston PD and his insurance company that his BMW had been stolen
from the street in front of his apartment while he slept. Everything went well, the BMW was valued and the
insurer was ready and willing to pay Raymond low blue book value on the
car. They did, however, automatically report the theft to the National
Insurance Crime Bureau (The "NICB") who records the vehicle
identification number of every vehicle ever shipped out of the United
States. The insurer was about to send a check to Raymond when it
received a report from NICB that the BMW had been shipped from Boston to
Belize three months before. The insurer assigned the investigation to its
Special Investigation Unit. Investigator Steve Nazarian went to
Raymond's home to interview him in detail. Raymond lied with alacrity
until he was confronted with the shipping documents. The ease with which
he had been caught frightened Raymond. He thought he might have to go to
jail. He knew there was no way to take back the reported theft. It was a
week before Christmas. He pleaded with Nazarian. "Just forget I made the claim. I will sign
any paper you ask to withdraw my claim. Getting me arrested won't help
you." Raymond suggested. "I just happen to have a release in my
briefcase, here. Please sign it. I will report you to the IFB but I will
also report that we settled with you for no payment as I am required to
do by law. They may have more important criminals to arrest than
you." "Give me the release." Raymond exclaimed
as he grabbed the release out of Steve Nazarian's hand and signed it.
"Now please leave my house." "Of course, Mr. Alexander, and have a Merry
Christmas." The Insurance Fraud Bureau had received, along
with Nazarian's report of Raymond's attempted fraud, 1800 reports of
suspected fraud for the month of November. His name was put in their
data base for future reference but no file was opened. Bigger and more
exciting fraud perpetrators took up their attention. No one was hurt. The insurance company paid no
money and immediately cancelled all policies it had for Raymond. Raymond went back to his regular work taking money
from widows, orphans, the sick and the partially criminal. He continued
to live well and never again committed insurance fraud. His Christmas
present to the insurance industry was to set his criminal mind to other
victims. This is, of course, a Christmas fable. All insurers do not run auto thefts through the
NICB or ISO database. Most insurers believe whatever the insured tells Most insurance criminals, unlike Raymond, know
about the lack of staff, how overworked and underpaid adjusters are, and
would never sign a release. The insurance criminal would either try to
bribe the SIU investigator or would sue the insurer for bad faith for
having the gall to claim they caught them at their crime. Insurance
fraud perpetrators do not give up a chance of easy money just because
their scheme did not hold together. They change the scheme and bluster. Insurers, faced with an expensive defense, will
pay something. Insurance criminals are not as naive as Raymond and
insurers are not as bright and forceful as his insurer. Steve would
never just give Raymond a release, he would need to consult with
management (up at least four layers) and a lawyer before he took such a
chance to defeat an insurance fraud. Insurance fraud perpetrators, even if they feel
they have been caught and will never recover merely redouble their
efforts and perpetrate more frauds so they can make up for the few where
they are caught. Raymond Alexander gave a Christmas present to the
insurance industry but is still loose to take advantage of the old, the
poor, and the weak who are prime candidates for a bunco artist.
Insurers, unlike an octogenarian widow, are better able to protect
themselves from a bunco scheme. If you are out there Santa, that is what I want as
a gift to me and the entire world, governments and insurers willing to
fight insurance fraud and give no quarter to the fraud. |