After noticing reoccurring suspicious claims activity with a large retail operation customer, its claims and Special Investigations Units helped federal postal inspectors unravel a scheme involving 33 individuals in Illinois and Wisconsin, who filed at least 60 claims with 16 insurance companies, including Zurich.
“We believe this scheme began in August 2005, and was still active until February 2009,” said Brian Wilson, VP of Zurich’s Special Investigative Unit. “Shutting down these fraud rings sends a clear signal that we are watching for fraudulent activity, and ultimately benefits our customers in the end by keeping their premiums lower.”
The group allegedly struck “big box” retailers, sometimes as frequently as two and three times a day. The scheme involved staging slip and fall accidents in a store. One individual set up the accident with liquid or paper on the floor, while another staged the fall. Others acted as lookouts, making sure no store management witnessed the “accident,” and then informed store officials of the incident.
Claims were filed under the retailers’ medical payment portion of their policy, meaning checks were typically mailed directly to the claimant. Each claim was in the $4,000-$8,000 range.
The Coalition Against Insurance Fraud statistics show 10% to15% of all claims contain some element of fraud.
“The current global economic crisis is spawning new and more creative fraud schemes,” said Jane Tutoki, chief claims officer for Zurich in North America. “We want it well known that Zurich is paying attention, and takes fraud seriously.”
