One of the most important attributes for anyone to hold who is involved in anti-fraud work is that of being diligent..

One recent claim involved an insured who reported vandalism to his car. It just so happens that the insured cooperated by submitting invoices for reimbursement for his car rental. One invoice didn't look exactly right to the claims examiner which triggered suspicion. The alert examiner faxed a copy of the car rental to the car rental firm. As originally suspected the car rental invoice had been made up and was fraudulent. (Did we neglect to say that the insured had sent in not ONE but TWO invoices to two different claim locations?)

The alert examiner authorized the subsequent investigation which revealed that the insured made the claim as an after thought while the car was in the body shop for a previous and reportedly unrelated claim. The insured had read his insurance policy and discovered that he may qualify for car rental so he did what any self-respecting greedy person might do, he simply made up the invoice on his personal computer.

When the insured was confronted about his actions admitted composing the invoices on his personal computer but rationalized that he had done nothing wrong since all he was trying to do was get the money which he deserved. (Have we heard that before?)

One other troubling aspect of this case concerns that fact that the insured is/was employee in a financial office in one the Bay Area counties. Just think, this happened before most people had even heard of ENRON.

Brent Harnish Mid mpis@pacbell.net
Peninsula Investigative Services)

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