The work of Zurich in North America’s Claims and special investigators helped federal postal inspectors unravel a “slip and fall” fraud scheme involving 33 individuals in Illinois and Wisconsin, who filed at least 60 claims with 16 insurance companies, including Zurich.
After noticing reoccurring suspicious claims activity with a large retail operation customer the insurer began investigating.
“We believe this scheme began in August 2005 and was still active until February 2009,” said Brian Wilson, vice president of Zurich’s Special Investigative Unit.
The group 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 look-outs, 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.
While the vast majority of insurance claims are honest and legitimate, the Coalition Against Insurance Fraud statistics show 10-15 percent 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.
“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,” Wilson added.
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