Insurance Claims Investigation News

March 27, 2007 – Phoenix, Ariz. – Insurance industry groups have banded together to create eight data initiatives and a central data repository to combat fraud, according to the keynote speaker at an industrywide meeting here of property/casualty claims and special investigations executives.

The initiatives are designed to improve data collection, data sharing and data analytics through the ISO ClaimSearch all-claims database, said Susan Q. Hood, claims vice president for Bloomington, Ill.-based State Farm Insurance Cos. and chairperson of an industry fraud data working group. Her remarks came at the 2007 Insurance Fraud Management Conference.

“Fraud is a huge problem, costing the insurance industry over $30 billion a year, and these initiatives will help the industry to better combat it,” Hood said.

The initiatives have been developed by a fraud data working group with members from insurance companies the Palos Hills, Ill.-based National Insurance Crime Bureau (NICB) and ISO Properties Inc., a Jersey City, N.J., provider of products and services intended to reduce risk. The aim is to make ISO\’s all-claims database a central repository for claims and fraud data.

“The specific initiatives will provide more actionable information for special investigations units and NICB investigators to improve their ability to identify fraudulent claims,” Hood told conference attendees.

The eight initiatives include revising reporting formats to and from ISO, adding optional data fields to the ISO database, changing the process for submitting questionable claims through ISO ClaimSearch to the NICB, and creating the ability to extract and sort data.

The initiatives will promote best practices and protocols for insurers’ timely and accurate submission of fraud-related data, says Richard Boehning, senior vice president of ISO.

“A number of the changes will affect the data that companies can submit and the data we can return for claims investigation,” Boehning said. “It will be important for companies to develop internal plans to adapt to the changes in order to capture the value intended.”

ISO and NICB sponsor the annual conference.

Liberty NY – Two police officers have been arrested and charged with having the same person wreck their vehicles to collect insurance money.

In one case, State Police at Liberty allege that William Kloss, III torched a 2005 Dodge Ram 2500 pickup truck for Edward Kowalik, Jr. Kowalik is a police officer with the New York City Department of Environmental Protection Police. Kowalik was having trouble making truck payments. He was charged with arson and insurance fraud.

Kloss was charged with torching the truck on February 26, 2007.

The investigation also revealed that on January 19, Kloss drove a 1999 Jeep Grand Cherokee and staged an accident so the vehicle’s owner, Amanda Cox, would make an insurance claim. Cox is a corporal with the Sullivan County Sheriff’s Office. She was arrested and charged with insurance fraud. She has also been suspended from the sheriff’s office pending further administrative action.

Cox, 25, who is a 3 ½ year member of the sheriff’s office, was recently promoted to the rank of corporal from deputy.

Sheriff Michael Schiff said the alleged incident took place while Cox was off-duty. “The results of this investigation were totally unexpected,” he said.

The investigation into the insurance scam operation could also potentially implicate a member of the Town of Fallsburg Police Department. That case is under investigation as well.

Police also learned that Kloss was allegedly involved in a staged accident March 2004 where he drove a 1994 Toyota pickup truck, owned by Michael Brooks of Jeffersonville, into a tree. Brooks collected insurance money for that.

Kloss was charged with arson with other charges expected, police said.