Want to see your insurance bills reduced? Report Insurance Fraud in South Carolina
Piedmont Area leads state in number of fraud cases Columbia, S.C. – Wednesday, July 11, 2007 – Governor Mark Sanford has proclaimed
July 15-21 as Insurance Fraud Awareness Week in South Carolina. Insurance fraud is a felony in South Carolina and can result in jail time.
Insurance fraud costs nearly $120 billion a year, with healthcare fraud at $85 billion a year and property and casualty insurance fraud at $30 billion a year, according to the Insurance Information Institute. Each year consumers spend about $300 per household just in additional insurance premiums, according to the National Insurance Crime Bureau. While there are organized fraud rings throughout South Carolina, other people you wouldn't suspect, such as a next-door neighbor, co-worker or close acquaintance, are also the causes of insurance fraud and increased insurance premiums.
The South Carolina Insurance Fraud Investigators, Attorney General Henry McMaster, and the South Carolina Insurance News Service are continuing their on-going initiative to fight insurance fraud and increase public awareness of insurance fraud and public participation in fraud prevention efforts.
Officials hope increased awareness of insurance fraud will encourage consumers to use the South Carolina Insurance Fraud Hotline to report cases to the Attorney General's Insurance Fraud Division.
The South Carolina Insurance Fraud Hotline (1-888-95-FRAUD) is available toll-free, 24 hours a day, 7 days a week. "People tolerate insurance fraud thinking that insurance companies have a lot of money, but that money is money paid into them in premiums from consumers. Reporting insurance fraud is the key to reducing this crime and saving money," says Allison Dean Love, Executive Director of the South Carolina Insurance News Service.
As of June 30, 2007, there have been 41 criminal convictions and 38 civil remedies in South Carolina as a result of insurance fraud charges, according to the Insurance Fraud Division of the Office of the Attorney General. According to the Attorney General’s 2006 report:
▪ There were 722 complaints of insurance fraud reported in South Carolina in 2006 – a 27% increase over 2005 with 569 cases.
▪ There were 49 civil remedies compared with 39 in 2005. There were 82 criminal convictions compared with 102 in 2005.
▪ The total amount of fraud reported in 2006 was $15.4 million – nearly triple the amount of 2005. (One liability fraud complaint of $10 million was reported)
▪ The amount of restitution ordered in 2006 was $318,125 – a 40% increase over 2005 with $191,416 in restitution.
The cases have come from all over the state of South Carolina and break down by region as follows:
▪ Piedmont - 31% (120)
▪ Low Country - 23% (89)
▪ Midlands - 27% (106)
▪ Pee Dee - 19% (74)The greatest number of complaints were due to
automobile insurance fraud (45%), followed by personal/commercial property fraud (14%) and workers' compensation fraud (13%). Fraud may be committed at different points in the insurance transaction by different parties: applicants for insurance, policyholders, third-party claimants and professionals who provide services to claimants.
Insurance fraud can be “hard” or “soft.” Hard fraud occurs when someone deliberately fakes an accident, injury, theft, arson or other loss to collect insurance money illegally. Soft fraud occurs when someone inflates a claim or underestimates the number of miles driven on an insurance application. Generally, the most prevalent types of insurance fraud are:
▪ Misrepresentation of the number of miles on an auto insurance application.
▪ Failure to report an accurate medical history when applying for health insurance.
▪ Fake or exaggerated injury claims to avoid work and draw workers’ compensation pay outs.
▪ Falsification or overstatement of injuries in auto accident to obtain a large settlement or damages award.
▪ Staged auto accidents that result in clams for non-existent or exaggerated injuries.
▪ Fabrication of relationships to obtain life insurance benefits.
▪ Exaggeration of the amount and value of items stolen from a home, business or automobile. In addition to denial of their claims and voiding of their insurance, people who commit insurance fraud risk criminal prosecution. As fraud increases, insurance companies have to cover these losses by increasing insurance rates. Insurance companies have special investigative units which are dedicated to reducing insurance fraud.
"Insurance fraud in South Carolina is causing honest people to pay far too much for insurance coverage," said Attorney General Henry McMaster. "We have a strong team that is vigorously prosecuting these crimes in our state, but citizens need to be alert and contact local law enforcement if they see evidence of insurance fraud. Criminals should not be allowed to make us all pay the bill for their crimes."
"We need the general public to fight fraud in our state and not tolerate it," said Brandolyn Pinkston, Administrator of the South Carolina Department of Consumer Affairs. "The message is a simple yet powerful one: We all pay for insurance fraud - it's time to fight back."
In recognition of Insurance Fraud Awareness Week, the South Carolina Insurance Fraud Investigators will be holding an Insurance Fraud Expo on Saturday, July 21 from 10:00 a.m. until 2:00 p.m. at the Kroger in Sparkleberry Square at the intersection of Two Notch Road and Sparkleberry Lane, Columbia. The expo will host a variety of booths available to help educate South Carolinians about the impact of insurance fraud in our state. Experts will be available to etch vehicle identification numbers on cars and explain auto theft prevention. “Governor Sanford’s proclamation clearly sends the message to the citizens of our state that insurance fraud is not only alive and well, but thriving - resulting in increased premiums and the cost of services provided by insurance companies who do business in South Carolina.” said Alan Wyche, President, South Carolina Insurance Fraud Investigators.
Other resources for information on insurance fraud are:
South Carolina Insurance News Service –
www.scinsnews.com National Insurance Crime Bureau –
www.nicb.orgCoalition Against Insurance Fraud –
www.insurancefraud.orgInsurance Fraud Division’s web site at -
www.scattorneygeneral.orgSouth Carolina Insurance Fraud Investigators -
www.sc-ifi.org Report Insurance Fraud to the South Carolina Insurance Fraud Hotline
1-888-95-FRAUD- All reports remain confidential.For more information on insurance fraud in South Carolina or for an interview call 803-252-3455 or e-mail
alove@scinsnews.comFor over 30 years, the South Carolina Insurance News Service, a nonprofit organization, has been providing free insurance information to consumers and the media about property and casualty insurance issues. The News Service is funded by insurance companies doing business in South Carolina. The Top 7 Most Outrageous Insurance Fraud Cases of 2007 (so far): Obsession Over Repossession On 07/24/06, Edward Pinckney claimed that his truck, valued at $15,000, was stolen from his home driveway. Investigation revealed that the truck was not stolen but repossessed by the State Credit Union. Before the repossession Mr. Pinckney was notified of the repossession by certified mail. On the day of the alleged theft, Mr. Pinckney had a three-way telephone conversation with Deputy Ballenger from the Greenville County Sheriff's office and Eric McIwain from the South Carolina Credit Union at which time he was made aware that the truck was not stolen, but was repossessed. On July 31, 2006, Mr. Pinckney completed and submitted a theft affidavit to State Farm Insurance Company, which indicated that his truck was stolen and not recovered and that he was unaware of its whereabouts. On 03/14/07, Mr. Pinckney pled guilty to Presenting a False Claim for Payment over $5,000. He was sentenced to 5 years suspended to 20 months probation.
Hail, No Hail! - On August 7, 2006, Joyce Davis submitted a witnessed statement to Hartford insurance company stating that her vehicle had been damaged by hail on May 20, 2006. Weather reports indicate there were no hailstorms or any rainstorms in the area on that date. Pictures of the vehicle in question show scratches in a swirl pattern as well as damages that appear to have come from a metal object that gouged the paint down to the metal. There was no damage to the top of the vehicle, only the hood, trunk, bumper, and sides. Ms. Davis claimed hail damage in the amount of $1,206.80. Her claim was denied and there was no restitution. Ms. Davis pled guilty to Presenting a False Claim for Payment, less than $1,000. She was sentenced to 30 days incarceration suspended to 6 months probation and a $200 fine.
3 Stooges and A Home Computer - On May 21, 2003, Linda Thompson was in a motor vehicle accident with her husband Matthew Barnes and her 17 year old daughter. Ms. Thompson did present to Cambridge Integrated Insurance Company forged medical billings for herself and her daughter totaling $4,452.00. The medical bills had the appearance of being typed on a home computer. Investigation found that one of the alleged medical facilities was actually a residential trailer park. Ms. Thompson also submitted billings from actual medical facilities; however, these medical facilities informed investigators that they never treated Ms. Thompson. The Insurance Company denied the claim. There was no restitution. On 01/30/07, she pled guilty to Presenting False Claims for payment. She was sentenced to 5 years in prison.
Grooms and Bride - On August 24, 2002 in Richland County, a rental car driven by Phyllis Harden allegedly rear-ended another vehicle containing the passenger Joseph Grooms. Mr. Grooms submitted to bodily injury claim to Cambridge Integrated Services, the insurance carrier for the rental car company. Mr. Grooms and Ms. Harden denied knowing each other when questioned by police and the insurance company. However, it was revealed that Mr. Grooms and Ms. Harden were in fact married. An expert in accident reconstruction examined the vehicles and determined that the damage to the vehicles was completely inconsistent with the accident scenario related to law enforcement and the insurance company. On 03/19/07, Ms. Harden pled guilty to Presenting False Claim for payment over $1,000. She was sentenced to one year in prison suspended to time served. There was $1,225.31 due in restitution to the victim in the case. The restitution was converted into a civil fine.
The “Buck” Stops Here – Quit Pulling Our Leg - Wyndell Buckmon defrauded an insurance company by claiming he was driving his car when the vehicle was involved in an accident and had lost his leg as a result. However, several witnesses who were involved in the accident indicated Buckmon was not in either car at the time of impact. In fact, the responding police officer drove up the road to the car wash where Buckmon was working at the time and brought him to the accident scene after-the-fact. The investigation further revealed that Buckmon had already lost his leg years prior to this incident. The insurance company denied his bodily injury claim. Buckmon pled guilty to presenting a false claim for payment and received a sentence of 18 months suspended to 18 months probation.
The Fake-out - Brion Smith defrauded an insurance company by submitting forms allegedly from two physicians indicating that he was disabled and unable to work. During this three-year period, Smith collected over $16,000 in disability payments. However, investigation revealed that neither physician had completed these forms. Smith pled guilty to two counts of making a false statement or misrepresentation and was sentenced to three years concurrent, suspended to four years probation, on each count. As part of his sentence, Smith also made full restitution of $16,549.
KARMA – Enough Said - Jimmy Mizzell, Sr., Kerry Mizzell, and George Reeves are family members who defrauded an insurance company by staging an automobile wreck. In fact, the setup went awry resulting in a more-serious wreck and injuries than they had intended. These defendants each pled guilty to presenting false claims for payment and received three years imprisonment, suspended to probation. In addition, the three were ordered to pay a total of over $23,000 in restitution.
Source: Insurance Fraud Division, Office of Attorney General Henry McMasterTo view Governor Mark Sanford’s Proclamation of Insurance Fraud Awareness Week, please link to:
Governor's Proclamation