Insurance Affairs

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Is there any single profession as glamorous as an insurance investigator?  We think not.  Then, again, we spend too much time at the movies.

In the real world, insurance investigators devote a significant amount of their time to investigating insurance fraud.  On the policyholder side, insurance fraud occurs when any act is committed with the intent to fraudulently obtain some benefit or advantage to which an insured or beneficiary is not otherwise entitled.  In the real world, insurance fraud is big business. Experts estimate that nearly $80B in fraudulent claims are made in the U.S. each year. Insurers are forced to perform the difficult balance between fighting fraud and avoiding bad faith claims.  Most insurers have implemented highly technical and strategic units to investigate and identify fraud.  Many risk managers are doing their part as well, particularly in the worker’s compensation arena.  Common red flags for identifying potential worker’s compensation fraud include accidents: occurring shortly after hiring, involving disgruntled or recent disciplined employees, and where the employer first learns about the injury from the employee’s attorney.  Insurance fraud is a crime in every state, and, as of late, state authorities are increasingly focusing on the involvement of attorneys in insurance fraud.

Earlier this year, disbarred attorney Miles Lamar Gammage pled guilty in the Northern District of Georgia to mail fraud for stealing $2.5 million in workers’ compensation settlement funds from 50 of his clients. Gammage settled many of the fraudulent cases without the knowledge of his clients and forged their signatures on their settlement checks so that he could keep the funds for personal use.  Los Angeles Attorney Susana Ragos Chung was disbarred earlier this year for her role in submitting false claims to insurance carriers based on the staged accidents and phony bills (and of course keeping portions of the payments made by insurance carriers for her own personal gain).

We don’t know the details of the investigations that led to the above actions against these attorneys, but we certainly hope they involved dancing.