By Brian Tenzer, Partner
In May, my partner Frank Goldstein joined some of the insurance industry’s most influential leaders at the FIFEC Conference in Orlando for a discussion on ways insurance companies and law enforcement can work together to eliminate fraud.
The presentation was well received and we received some excellent feedback. In particular, there were questions about how insurance companies and their legal teams can build the strongest case possible for the Florida Department of Financial Services (DFS) – one that is more likely to result in an investigation and prosecution.
Here are some tactics I’d like to share:
The Five Ws + How – Who, what, where, when, why, how. Grade-schoolers learn these are the basics to a good story. They also should be the foundation of every DFS submission. Answer the five Ws and How with accurate facts, including surveillance, witness statements, medical records and confessions. Don’t editorialize, add gratuitous comments, draw conclusions or speculate.
Timeliness – Insurance companies are required to immediately report suspected fraud to DFS. But timely reporting shouldn’t end with the initial outreach. Over time, evidence can become stale, spoiled or even disappear. The statute of limitations against a fraud suspect could run out, or perpetrators might flee the country. When building a case, it’s essential to continually share details with DFS as the case comes together.
Cooperation – Suspected fraud is one of the few instances in which insurance companies are legally permitted to communicate with each other. Since fraud rings often target multiple carriers, this interaction can result in a gold mine of shared factual evidence, which should be turned over to DFS.
In conclusion, there’s no one “silver bullet” to ensure fraud conviction, but following some basic rules can significantly increase the probability.
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