Fraud is a crime whether it is a so-called “soft fraud” or a hard fraud.
Both should be prosecuted to the full extent of the law.
Continue in the efforts to defeat insurance fraud and don’t make a fraud perpetrator a nice person because they only took to fraud to add to a legitimate claim. Whether they intentionally burn down their house to profit or just add a tv set to a legitimate burglary. Both are criminal conduct.
Is it soft fraud if a carriers adjuster over states depreciation or under states unit cost or quantities. Remember the scope of damages is an ESTIMATE.
With contents the carrier usually gets the better end of it as each item must be listed. Most un-represented insureds just miss so many items that their claim lower that actual.
As to estimating age, well there is a over used factor in determining AVE. So my 12 month old shoes are depreciated the same as grandpa’s shoes. So because he only wares them on Sunday has no factor. So is it soft fraud if carrier does not take into consideration all factors.
Fraud requires the following: 1. A misrepresentation or concealment of a material fact; 2. the misrepresentation must be made with the intent to deceive; 3. the insurer is actually deceived; and the deception causes damage to the insurer.
The elements work the same way if done by the insurer.
I agree with points 1 and 2 but disagree with number 3. The insurer need only have a suspicion of fraud for it to meet the definition of reportable fraud in many states. Whether or not the insurer is deceived or damaged does not fit into the equation.
If it in fact go both ways then if the insured has a suspicion of fraud should it be investigated as rigorously by DFS as a carrier reporting fraud. Insureds are deceived all the time by carriers that fail to disclose all the insureds right as will as responsibilities. Disclosing both is required by Statute and Rule.
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Fraud is a crime whether it is a so-called “soft fraud” or a hard fraud.
Both should be prosecuted to the full extent of the law.
Continue in the efforts to defeat insurance fraud and don’t make a fraud perpetrator a nice person because they only took to fraud to add to a legitimate claim. Whether they intentionally burn down their house to profit or just add a tv set to a legitimate burglary. Both are criminal conduct.
Mr. Rock and other:
Is it soft fraud if a carriers adjuster over states depreciation or under states unit cost or quantities. Remember the scope of damages is an ESTIMATE.
With contents the carrier usually gets the better end of it as each item must be listed. Most un-represented insureds just miss so many items that their claim lower that actual.
As to estimating age, well there is a over used factor in determining AVE. So my 12 month old shoes are depreciated the same as grandpa’s shoes. So because he only wares them on Sunday has no factor. So is it soft fraud if carrier does not take into consideration all factors.
With Interest
Mark D Boardman
Fraud requires the following: 1. A misrepresentation or concealment of a material fact; 2. the misrepresentation must be made with the intent to deceive; 3. the insurer is actually deceived; and the deception causes damage to the insurer.
The elements work the same way if done by the insurer.
I agree with points 1 and 2 but disagree with number 3. The insurer need only have a suspicion of fraud for it to meet the definition of reportable fraud in many states. Whether or not the insurer is deceived or damaged does not fit into the equation.
Reporting a suspected fraud does not require proof of fraud. But if you deny a claim for fraud you must prove all of the elements of the tort.
If it in fact go both ways then if the insured has a suspicion of fraud should it be investigated as rigorously by DFS as a carrier reporting fraud. Insureds are deceived all the time by carriers that fail to disclose all the insureds right as will as responsibilities. Disclosing both is required by Statute and Rule.