Insurance Claims - Dirty Tricks

DFW Roofing · Jan 17, 2012

I will be speaking to a group on insurance fraud investigators next month. I know most of the dirty tricks bad contractors pull (which often cross the line into fraud) but would like this group to share some stories here for me.

Thanks in advance.

A&E Exteriors · Jan 17, 2012

I've heard of using spoons and ball peen hammers to create "hail damage"

smalpierre · Jan 17, 2012

They use coins too. I just got HAAG certified, and they go into fraudulent claims quite a bit. If you know what to look for, you can tell the difference.

smalpierre · Jan 17, 2012

A couple of incidents were found out because the guy that went up there whackin and scrapin left the tools up there :laughing: :laughing:

eagleandbaby · Jan 18, 2012

I went to a HAAG seminar last week too. The presenter told a story of an adjuster who had to pay an Insured $25k for a 'missing' diamond ring when he knew the guy was lying.

A couple years later he went back to the same house to view a roof with 'hail' damage. He recognized the guy from the last claim.

When he was on the roof a neighbor poked his head out the window and said to 'come over' when he was done. When the adjuster when to the neighbor’s house, he was showed a video of the guy on the roof hammering away.

He said he snitched on his neighbor because he had killed his dog a while back.

The adjuster called the cops and the guy went to prison for 5 years.

Nice story. Sad but, nice.
.

A&E Exteriors · Jan 18, 2012

eagleandbaby said:
I went to a HAAG seminar last week as well. The presenter told a story of and adjuster who had to pay an insured $25k for a 'missing' diamond ring when he just knew the guy was lying.

A couple years later he went back to the same house to view a roof with 'hail' damaged. He recognized the guy from the last claim.

When he was on the roof a neighbor poked his head out the window and said to 'come over' when he was done. When the adjuster when tot the neighbor’s house, the neighbor showed him a video of guy filing the claim on the roof hammering away. He said he snitched on his neighbor because he had killed his dog a while back.

The adjuster called the cops and the guy went to prison for 5 years.

Nice story.
.

Sweet, I hate pr!ks like that

cleveman · Jan 18, 2012

An interesting thing for me right now would be to check on people who are being foreclosed upon.

We've all seen or heard of houses being stripped. I've asked, "why aren't these guys being prosecuted?"

The answer is that you have to prove who did it. And if you do that, they can always say they were in the middle of a remodeling project, then the house was suddenly taken away from them.

Anyway, I would bet that between the owner/occupier and the banks, someone is reporting a theft.

Maybe the homeowner removes all the appliances, furnace, etc. and reports a theft and turns it into his insurance.

Maybe the bank has insurance for this. They get a house back with everything intact and go and strip it and report a theft and collect.

Maybe a realtor lists a house and all the appliances show up missing and they call in a theft. That would only be theft, not insurance fraud. But maybe they are in bed with the bank, and the bank gets the insurance claim and splits it.

So check into that end of it.

MJW · Jan 18, 2012

Kinda far fetched stories from Haag, almost as bad as their recognition of damage.

It's documented on the net in several places, when and where hail has impacted an area.

The worst I've seen lately is Ins. Companies and their adjusters trying to stiff the Insured.

thom · Jan 18, 2012

MJW said:
The worst I've seen lately is Ins. Companies and their adjusters trying to stiff the Insured.

I've had a few dealings with insurance companies. I believe there is far more abuse on the part of insurance companies than by the insureds.

Willy is · Jan 18, 2012

It's interesting to talk with people following a hail storm. Some people get total coverage and others find that they were not in "good hands" after all. I've seen this dynamic a few times (following various types of storm damage) and it often seems like the same companies have differing thresholds for coverage.

RandyB1986 · Jan 18, 2012

MJ and Thom are correct. The only crooks I have dealt with lately is the adjusters themselves!

Indianapolis, Indiana – June 30, 2011
– A six-week trial in Hamilton County Court ended yesterday afternoon with the award of a $14.5 million jury verdict for Joseph Radcliff and his restoration company, CPM Construction of Indiana, against State Farm Insurance.

State Farm had filed suit for insurance fraud and RICO (Racketeer Influenced and Corrupt Organizations) claims against Radcliff and CPM. The case arose out of work done by Radcliff and CPM following the April 2006 hailstorm. Radcliff and CPM’s allegations were that after State Farm received negative publicity in the Indianapolis media for denying hail damage claims, State Farm made unfounded claims of fraud against Radcliff and instigated the filing of felony charges against him. Those charges were dismissed by the Marion County Prosecutor, but the negative publicity resulted in Radcliff’s personal
reputation and business being destroyed.

Not only did the jury find that State Farm’s claims against Radcliff were baseless, but they also found that the Radcliff’s allegations of being defamed by State Farm were true. The jury ordered State Farm to pay Radcliff $14.5 million.

jmiller · Jan 18, 2012

When there was a big hail storm here in 'o6 State Farm accused a local contractor of felony insurance fraud for creating fake hail damage. Come to find out, it was actually one of their adjusters who did it, and the contractor was awarded 14.5 million for defamation. :detective:

http://www.wishtv.com/dpp/news/local/hamilton_county/judge-state-farm-owes-fishers-contractor-145m

jmiller · Jan 18, 2012

Beat me to it!

TNTRenovate · Jan 19, 2012

Willy is said:
It's interesting to talk with people following a hail storm. Some people get total coverage and others find that they were not in "good hands" after all. I've seen this dynamic a few times (following various types of storm damage) and it often seems like the same companies have differing thresholds for coverage.

I remember growing up back in the Dallas/Ft. Worth area, we had a major T-Storm roll through. Hail the size of golf balls. The guy behind our house got a new roof. So my dad calls the ins company and they say, sorry no damage.

The guy to our left gets a new roof. My dad calls the ins company back and they say, sorry no damage.

The guy to the right gets a new roof. My dad calls ins company back out, they say sorry no damage.

A month later every single house on the block has a new roof. My dad calls back and says, deny my claim, but I want to know how the house behind me and to both sides of me got hailed on and we were spared?

A week later the check came for a new roof. After that, he dropped them and found a new company. My dad went up on the roof with the roofer and they found all the flashing dented and 80% of the roof damaged.

smalpierre · Jan 19, 2012

I won't comment on which ones, but there is at least one insurance company I wouldn't trust to insure anything.

bender_dundat · Jan 19, 2012

RandyB1986 said:
MJ and Thom are correct. The only crooks I have dealt with lately is the adjusters themselves!

Indianapolis, Indiana – June 30, 2011
– A six-week trial in Hamilton County Court ended yesterday afternoon with the award of a $14.5 million jury verdict for Joseph Radcliff and his restoration company, CPM Construction of Indiana, against State Farm Insurance.

State Farm had filed suit for insurance fraud and RICO (Racketeer Influenced and Corrupt Organizations) claims against Radcliff and CPM. The case arose out of work done by Radcliff and CPM following the April 2006 hailstorm. Radcliff and CPM’s allegations were that after State Farm received negative publicity in the Indianapolis media for denying hail damage claims, State Farm made unfounded claims of fraud against Radcliff and instigated the filing of felony charges against him. Those charges were dismissed by the Marion County Prosecutor, but the negative publicity resulted in Radcliff’s personal
reputation and business being destroyed.

Not only did the jury find that State Farm’s claims against Radcliff were baseless, but they also found that the Radcliff’s allegations of being defamed by State Farm were true. The jury ordered State Farm to pay Radcliff $14.5 million.

I won't say much because I don't want to take the chance of getting sued by this guy. From everything I've heard from a number of different sources, this finding was more because of SF jumping the gun on the prosecution than this guy being innocent.

room2roof · Jan 23, 2012

I think anyone that causes damage intentionally should be locked up and never allowed to obtain a contractors license or Adjusters license again in any State as well as have their name on a list for insurance companies to refer to for future claims.

I'm not trying to get all "preachy" here but karma is a ***** when it comes back around to bite you and even if you never get caught you will find your good fortune dwindling and it all comes crashing down when you least expect it....... Fly Straight and always give your best to each customer things will always work in your favor if you do it right.

charlotte roofing company, charlotte nc roofers, roofing companies nc, roof contractors, roof repairs north carolina

DFW Roofing · Jan 23, 2012

Thanks for stories - far more fraud than just mechanical damage.

False invoices covering deductibles is a big one.

cleveman · Jan 23, 2012

What would people think if contractors worked for insurance claims at a 40% discount off their normal rates?

Now apply this to the medical field.

larryb · Jan 23, 2012

RandyB1986 said:
MJ and Thom are correct. The only crooks I have dealt with lately is the adjusters themselves!

Indianapolis, Indiana – June 30, 2011
– A six-week trial in Hamilton County Court ended yesterday afternoon with the award of a $14.5 million jury verdict for Joseph Radcliff and his restoration company, CPM Construction of Indiana, against State Farm Insurance.

State Farm had filed suit for insurance fraud and RICO (Racketeer Influenced and Corrupt Organizations) claims against Radcliff and CPM. The case arose out of work done by Radcliff and CPM following the April 2006 hailstorm. Radcliff and CPM’s allegations were that after State Farm received negative publicity in the Indianapolis media for denying hail damage claims, State Farm made unfounded claims of fraud against Radcliff and instigated the filing of felony charges against him. Those charges were dismissed by the Marion County Prosecutor, but the negative publicity resulted in Radcliff’s personal
reputation and business being destroyed.

Not only did the jury find that State Farm’s claims against Radcliff were baseless, but they also found that the Radcliff’s allegations of being defamed by State Farm were true. The jury ordered State Farm to pay Radcliff $14.5 million.

The "jury" is still out on that one...

Insurance Claims - Dirty Tricks

DFW Roofing

A&E Exteriors

smalpierre

smalpierre

eagleandbaby

A&E Exteriors

cleveman

MJW

thom

Willy is

RandyB1986

jmiller

jmiller

TNTRenovate

smalpierre

bender_dundat

room2roof

DFW Roofing

cleveman

larryb

Top Contributors this Month

Recommended Communities