Motor Vehicle Insurance Fraud and Related Crimes
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Long-Term Care Insurance Policy
NEW YORK LIFE INSURANCE COMPANY 51 Madison Avenue, New York, NY 10010 New York Life, Long-Term Care Insurance (800) 224-4582 www.newyorklife.com Long-Term Care Insurance Policy FEDERAL TAX-QUALIFIED COVERAGE: THIS CONTRACT FOR LONG-TERM CARE INSURANCE IS INTENDED TO BE A FEDERALLY QUALIFIED LONG-TERM CARE INSURANCE CONTRACT AND MAY QUALIFY YOU FOR FEDERAL AND STATE TAX BENEFITS. THIS POLICY IS AN APPROVED LONG-TERM CARE INSURANCE POLICY UNDER CALIFORNIA LAW AND REGULATIONS. HOWEVER, THE BENEFITS PAYABLE BY THIS POLICY WILL NOT QUALIFY FOR MEDI-CAL ASSET PROTECTION UNDER THE CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE. FOR INFORMATION ABOUT POLICIES AND CERTIFICATES QUALIFYING UNDER THE CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE, CALL THE [HEALTH INSURANCE COUNSELING AND ADVOCACY PROGRAM AT THE TOLL-FREE NUMBER 1 (800) 434-0222. This Policy is a legal contract between You and New York Life Insurance Company (herein called We, Us, and Our). Please read this Policy carefully and in its entirety. It is issued in exchange for Your Application, and payment of required premiums. This is a long-term care insurance policy that covers Nursing Facility Care, Residential Care Facility, and Home and Community Based Care. 30 Day Free Look Period. Please examine Your Policy promptly. Within 30 days after delivery, You can return the Policy by first class United States mail to New York Life Insurance Company. Upon our receipt of Your Policy a full premium refund will be made to You within 30 days of the Policy’s return and coverage will be void from start. PARTICIPATING. -
Illinois Mandatory Insurance Brochure
The Illinois Department of Insurance regulates insur- IF YOU ARE INVOLVED ance companies, agencies and agents. It maintains a IN AN ACCIDENT Consumer Services Division that can answer your questions about auto insurance. If you have questions An accident report form must be filed with the Illinois or wish to file a complaint, please contact: Department of Transportation (IDOT) if damages exceed Mandatory Vehicle $500 or if injuries resulted from the accident. At-fault, Illinois Department of Insurance uninsured motorists are required to pay for damages 320 W. Washington St. they cause or face license plate registration and driver's Springfield, IL 62767-0001 INSURANCE license suspensions. www.state.il.us/ins/ The Secretary of State's office does not maintain insur- ance information for all registered motor vehicles. FOR MORE INFORMATION Insurance information is available only from the motorist involved in the accident or from the report filed with For more information about Illinois’ Mandatory Insur- IDOT. ance Law, please contact: For more information on reporting an accident, please Office of the Secretary of State contact: Mandatory Insurance Division 501 S. Second St. Illinois Department of Transportation 429 Howlett Bldg. Office of Planning and Programming Springfield, IL 62756-7000 Bureau of Data Collections 217-524-4946 2300 S. Dirksen Pkwy. Springfield, IL 62764 217-782-4518 PURCHASING INSURANCE Contact an insurance agent to buy liability insurance for your vehicle. Some companies do not sell insurance to vehicle owners who have been driving uninsured. If you have problems buying insurance, ask your insur- ance agent about the Illinois Automobile Insurance Plan. -
Insurance Fraud Is a Felony
1-800-927-4357 www.insurance.ca.gov Insurance Fraud Is a Felony Dave Jones, Insurance Commissioner California Department of Insurance STATE OF CALIFORNIA DEPARTMENT OF INSURANCE 300 S. Spring Street, South Tower Los Angeles, CA 90013 Dear California Consumer: Thank you for contacting the California Department of Insurance (CDI). As part of our effort to build the best consumer protection agency in the nation, we have created this guide to provide consumers the information and tools to deal effectively with agents, brokers, and insurance companies. We are committed to finding solutions and taking immediate action to help eliminate the many problems now occurring in homeowners, health, and workers’ compensation insurance, as well as consumer privacy protection. These important insurance issues speak to the very fabric of our social economic system and to the future strength of our society and economy in California. Please feel free to contact our Consumer Hotline at 800-927-HELP (4357) if you have further questions about this guide, or if you are experiencing a problem with an agent, broker, or insurance company. The Hotline is staffed by knowledgeable insurance professionals who are ready to assist you with your insurance needs. If you are interested in other insurance topics, CDI has a full range of insurance guides available on our website at www.insurance.ca.gov, or by calling our Consumer Hotline. Thank you for giving us the opportunity to serve you. 3 Table of Contents Fraud Division Overview ...................................................................5 What is Insurance Fraud. ....................................................................7 Insurance Fraud Costs Consumers .................................................9 Common Insurance Fraud Schemes ........................................... 10 Automobile Insurance Fraud........................................................ -
A Consumer Guide to Insurance Fraud
A CONSUMER GUIDE TO INSURANCE FRAUD A CONSUMER GUIDE TO INSURANCE FRAUD INSURANCE ADMINISTRATION A CONSUMER GUIDE TO INSURANCE FRAUD TABLE OF CONTENTS Introduction . 1 Insurance Fraud . 1 What Is Insurance Fraud? . 2 Consequences of Insurance Fraud . 4 Fraud Against Seniors . 5 Fraud Against Businesses . 6 Drug and Health Discount Programs . 8 Avoid Being A Victim . 9 Additional Tips To Protect Yourself Against Insurance Fraud . 10 What To Do If You Are Involved In An Auto Accident . 12 Report Insurance Fraud . 14 Maryland Insurance Administration • 800-492-6116 • www.insurance.maryland.gov A CONSUMER GUIDE TO INSURANCE FRAUD INTRODUCTION The Maryland Insurance Administration (MIA) is an independent state agency that regulates Maryland’s insurance marketplace and protects consumers by ensuring that insurers and insurance producers (agents and brokers) act in accordance with insurance laws . We produced this guide to help educate Maryland residents about insurance fraud . The Insurance Administration also is responsible for investigating and resolving complaints and questions concerning insurers that conduct business in Maryland . INSURANCE FRAUD Insurance fraud is one of the most costly white-collar crimes in America . Insurance fraud ends up increasing the amount everyone pays in insurance premiums to offset the cost of the fraud . By law, all applications for insurance and all claim forms must contain the following statement, or a substantially similar one: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison . -
February 1, 2018 MASSACHUSETTS PRIVATE PASSENGER RESIDUAL MARKET AUTOMOBILE INSURANCE MANUAL
MASSACHUSETTS PRIVATE PASSENGER RESIDUAL MARKET AUTOMOBILE INSURANCE MANUAL SECTION I - GENERAL RULES RULE 1. ELIGIBILITY All individually owned vehicles registered under the Massachusetts Compulsory Motor Vehicle Law that are eligible for private passenger motor vehicle insurance under the rules of the Massachusetts Automobile Insurance Plan (MAIP) may be rated in accordance with this manual and written on the Massachusetts Automobile Insurance Policy. RULE 2. COVERAGES AND LIMITS The types of coverages available in the CAR Massachusetts Automobile Insurance Policy are: Compulsory Insurance Coverages Part 1 - Bodily Injury to Others The basic limits are $20,000 each person and $40,000 each accident. Part 2 - Personal Injury Protection The basic limit is $8,000 for each person. Refer to Rule 30 for available deductibles. Part 3 - Bodily Injury Caused By an Uninsured Auto The basic limits are $20,000 each person and $40,000 each accident. Increased limits are available. The limits may not exceed the limits of Part 5, or if Part 5 is not purchased, Part 1 of this policy. This coverage is excess over Personal Injury Protection. Part 4 - Damage to Someone Else’s Property The basic limit is $5,000 each accident. Increased limits are available. Optional Insurance Coverages Part 5 - Optional Bodily Injury to Others The basic limits are $20,000 each person and $40,000 each accident. Increased limits are available. Part 6 - Medical Payments The basic limit is $5,000 each person. Higher limits are available for all motor vehicles rated in this manual. Motorcycle limits are available from $500 to $25,000. This coverage is excess over Personal Injury Protection. -
60 Charged in Fall Insurance Fraud Sweep
___________________________________________________________________________________________________________________________________ October 2018 60 Charged in Fall Insurance Fraud Sweep October 2017. On November 13, Harper allegedly filed a claim indicating that 18 items were stolen from his vehicle. Harper • On October 9, 2018, allegedly provided Mark Folino was Allstate with fraudulent arrested in Lawrence receipts for mink coats County. According to and jackets the criminal complaint, purportedly valued at on March 13, 2018, at more than $43,000. approximately 12:49 Investigators spoke to the owner of the men’s PM, Folino rear-ended a store listed on the receipts. The owner State Farm insured allegedly advised that his store did not issue vehicle which was the receipts and did not sell coats at such high- attempting to make a end prices. Allstate denied the claim. Harper left hand turn into a was charged with one count of Insurance Fraud driveway. The complaint stated that when the (F3), one count of Theft by Deception (F3), one accident occurred, Folino was listed as an count of Forgery (F3) and one count of excluded driver on the Progressive Criminal Use of a Communication Facility (F3). Insurance vehicle policy shared by Folino and his wife. Approximately one hour after the • On October 25, 2018, accident, Folino’s wife allegedly added him to Kennesha Watson the policy as a covered driver. Folino allegedly was arrested in contacted Progressive later that day and filed Montgomery County. a claim for the accident, stating that the crash According to the occurred after he was added to the policy as a criminal complaint, on covered driver. However, the complaint stated September 20, 2017, that investigators reviewed the Pennsylvania Watson’s uninsured State Police incident report which confirmed vehicle was involved that the loss occurred prior to the policy in an accident. -
Cyber-Insurance: Fraud, Waste Or Abuse?
#RSAC SESSION ID: STR-F03 Cyber-Insurance: Fraud, Waste or Abuse? David Nathans Director of Security SOCSoter, Inc. @Zourick #RSAC Cyber Insurance overview One Size Does Not Fit All 2 #RSAC Our Research Reviewed many major policies and some not so major… Spoke with Insurance agencies Spoke with Insurance agents Reviewed policies currently held by customers Got paid by insurance companies to perform Incident Response, forensics and breach analysis 3 #RSAC Types of Insurance Loss of digital assets Damage, alteration, corruption, distortion, theft, misuse, distortion (caused by damage or destruction, operational mistakes, computer crime such as malware, etc) ** NOT RANSOMWARE Non-physical business interruption interruption, degradation in service (caused by damage or destruction, operational mistakes, computer crime such as malware, etc) Cyber Extortion Threat Must get express written consent to pay from insurance company and contact authorities (FBI) all prior to paying any extortion money 4 #RSAC Types of Insurance Security Event Costs / Crisis Management Covers costs associated with resolving a breach, fines by government, regulatory or civil court. Other money for brand harm Network security and privacy Covers claims against you for acts, errors & omissions made by you and your contractors that results in a breach. (Not your breach, this is for a breach you caused somewhere else) 5 #RSAC Types of Insurance Employee Privacy Liability Covers damages to employees resulting in a breach Electronic Media Liability Covers plagiarism or copyright infringement on your website Cyber Terrorism Covers system outage due to terrorism (gov, political, ideological motivation) 6 #RSAC Types of Insurance Identity theft Covers the specific costs associated with notification of victims, credit monitoring, etc. -
Pattern Criminal Jury Instructions for the District Courts of the First Circuit)
UNITED STATES DISTRICT COURT DISTRICT OF MAINE 2019 REVISIONS TO PATTERN CRIMINAL JURY INSTRUCTIONS FOR THE DISTRICT COURTS OF THE FIRST CIRCUIT DISTRICT OF MAINE INTERNET SITE EDITION Updated 6/24/19 by Chief District Judge Nancy Torresen PATTERN CRIMINAL JURY INSTRUCTIONS FOR THE FIRST CIRCUIT Preface to 1998 Edition Citations to Other Pattern Instructions How to Use the Pattern Instructions Part 1—Preliminary Instructions 1.01 Duties of the Jury 1.02 Nature of Indictment; Presumption of Innocence 1.03 Previous Trial 1.04 Preliminary Statement of Elements of Crime 1.05 Evidence; Objections; Rulings; Bench Conferences 1.06 Credibility of Witnesses 1.07 Conduct of the Jury 1.08 Notetaking 1.09 Outline of the Trial Part 2—Instructions Concerning Certain Matters of Evidence 2.01 Stipulations 2.02 Judicial Notice 2.03 Impeachment by Prior Inconsistent Statement 2.04 Impeachment of Witness Testimony by Prior Conviction 2.05 Impeachment of Defendant's Testimony by Prior Conviction 2.06 Evidence of Defendant's Prior Similar Acts 2.07 Weighing the Testimony of an Expert Witness 2.08 Caution as to Cooperating Witness/Accomplice/Paid Informant 2.09 Use of Tapes and Transcripts 2.10 Flight After Accusation/Consciousness of Guilt 2.11 Statements by Defendant 2.12 Missing Witness 2.13 Spoliation 2.14 Witness (Not the Defendant) Who Takes the Fifth Amendment 2.15 Definition of “Knowingly” 2.16 “Willful Blindness” As a Way of Satisfying “Knowingly” 2.17 Definition of “Willfully” 2.18 Taking a View 2.19 Character Evidence 2.20 Testimony by Defendant -
Tackling Health Insurance Fraud
SPECIAL FEATURE – CLAIMS Tackling health insurance fraud Mr Colin Weston of RGA looks at what is being done to combat the growing phenomenon of health insurance fraud, and whether more actions are needed. t is impossible to accurately quantify the cost of health Perpetrators and types of fraud insurance fraud but, with real and sustained growth It is known that professional criminals have targeted Iboth of premiums and number of lives covered, the health insurers, in some cases setting up complex frauds. problem is set to escalate. In the US, which spends more These include fraudsters in the UK who, having previously on health than any other country in the world (16.2% of gained access to patients’ insurance details by collaborating GDP in 2009, according to the World Health Organiza- with motorcycle couriers used to transport specimens and tion), it is estimated that between US$68 billion and $175 accounting information, continued to bill unsuspecting in- billion is lost annually to health fraud. surers for a number of years after the closure of a pathology The problem may not be on the same scale in the MENA laboratory. In India, fraudsters targeted a government-run region, but there is already evidence that it is a real concern. scheme for those living below the poverty line by colluding In January 2010, the Health Authority of Abu Dhabi (HAAD) with such residents in the state of Kanpur to submit claims took 39 patients, doctors and insurers to court for a variety for fictitious treatment. of offences, including charging for medical services that had However, the majority of fraud involves real patients who not been provided, making fraudulent claims and using are often unsuspecting bystanders, unaware that anything is fake insurance cards. -
NYSDFS: NYSID Annual Report of the Superintendent of Insurance to The
Annual Report of the Superintendent of Insurance to the New York Legislature Calendar Year 2001 Governor George E. Pataki Superintendent of Insurance Gregory V. Serio www.ins.state.ny.us The One Hundred Forty-Third Annual Report of the Superintendent of Insurance A Report to the New York State Legislature for the Year Ending December 31, 2001 George E. Pataki Gregory V. Serio Governor Superintendent of Insurance www.ins.state.ny.us Data in this report are subject to small table-to-table variations. Such variations are attributable to the fact that data are retrieved at various times throughout the year. Selected portions of this report are available on the Department’s Web site at www.ins.state.ny.us This report is printed on recycled paper. L: gen/Annrpt00/Ar-oov2 TABLE OF CONTENTS Page I. MAJOR DEVELOPMENTS A. September 11……………….….………………………………………………………..… 1 B. Superintendent Serio Appointed…………………………………………….………… 2 C. Terrorism Exclusion......……………...........................................................…........... 2 D. Healthy NY………………………………………………………………………………….. 3 E. Speed to Market……………………………………………………………..…………..… 3 F. Gramm-Leach-Bliley Act…………………………………………………………………. 3 G. Automobile……………………………………………………………………………….… 4 H. Property/Casualty (Non-Auto)..….............…………………………………...........….. 5 I. Health………….……………….………...................................................................…... 5 J. Life.........…………………......……...……………………………................................…. 6 K. Consumer Services..............................................………………......................…..... -
Insurance Fraud… What the Future May Hold
Insurance Fraud… What the Future May Hold THE SURPLUS LINE ASSOCIATION OF CALIFORNIA Tuesday, April 18, 2017, Universal City Wednesday, April 19, 2017, San Francisco Introduction and Overview The New … • Predictive Modeling • Assignment of Benefits (AOB’s) • CEOs going to Jail for Fraud • Financial Fraud at the Corporate Level • Internal ID and Extortion Fraud • Internal Consultants and Internal Fraud • Social Engineering & Wire Fraud • When Good Employees go Bad and the Mundane … • Staged Auto Crashes • Arson © 2016 Fisher Consulting Group, Inc. Reducing the $300B Fraud Industry The Yates Memo • More Intrusive Monitoring - Claims data finds abuse, fraud, and waste Arizona and California Auto Insurance Fraud Busts • Detecting red flags on a fraudulent auto claim • Interdepartmental Co-operation • New “Secret” Device • According to NICB, testers were able to open 54% of the vehicles and drive away with half of them! • Of those driven away, 2/3 were then restarted using the device • Many time the owner believes the vehicle has been towed Identify theft and loss of financial information is one of the primary concerns for those in the financial and retail industries © 2016 Fisher Consulting Group, Inc. The “new normal” 75% of companies surveyed had been victims of fraud in the past year—a 14- percentage point from three 2016 years earlier. 73 * 2015-16 Global fraud report by Kroll, Inc. 75 and The Economist Intelligence Unit 73% of finance 2013 professionals 61 reported an attempted or actual payments fraud in 2015. Victims of Fraud Attempted Fraud *The Association For Financial Victims of Fraud Attempted Fraud Professionals’ 2016 Payments Fraud and Control Survey Source: www.McKinsey.com © 2016 Fisher Consulting Group, Inc. -
Forgery, Fraud and Other Charges As Part of a Scheme to Defraud Their Insurance Carrier
ALBANY COUNTY In the City of Albany, a brother and sister face a range of charges including: forgery, fraud and other charges as part of a scheme to defraud their insurance carrier. Michael and Mary Beth Maxwell are accused of submitting false claims to the Progressive Insurance Company for lost wages totaling $8,711 as the result of an auto accident. The complaint alleges that Mr. Maxwell forged a letter from Ms. Maxwell’s former employer falsely stating that she was scheduled to return to work on December 11, 2002. In reality, Ms. Maxwell was terminated by the employer a month earlier and was not entitled to any lost wages. The defendants are charged with four counts: Forgery in the Second Degree; Insurance Fraud in the Third Degree; Falsifying Business Records in the First Degree; and Attempted Grand Larceny in the Third Degree. BROOME COUNTY In Binghamton, a couple was charged with falsifying records and other charges as part of a scheme to defraud their insurance carrier. Michael DeLuca and Angela Smith are accused of submitting falsified documents to the Liberty Mutual Insurance Company. The couple falsely reported the date of a car accident in order to make a $1,200 claim on an insurance policy that was cancelled because of Ms. Smith’s failure to pay required premiums. The defendants are charged with Insurance Fraud in the Fourth Degree, Falsifying Business Records in the First Degree, Attempted Grand Larceny in the Fourth Degree, Falsely Reporting an Incident in the Third Degree and Conspiracy in the Fifth Degree. In another Broome County case, a Binghamton man was charged in connection with a staged accident in a shopping plaza parking lot.