Tag Archives: PIP fraud

Operation Sledgehammer Arrests another Staged Accident Recruit

Ricardo Pargas, 49, of West Palm Beach was arrested on Wednesday, September 24, 2014 for his participation in a staged auto crash ring, according to the Sun-Sentinel.

Acting on information from Allstate Insurance and the FBI, the Florida Division of Insurance Fraud discovered that Pargas and his wife had participated in a staged car crash while acting on directions from the fraud scheme’s ringleader, Alien Moya, 30, also of West Palm Beach. The couple, recruited by Moya, was paid $2,000 each for their part in the crash. As of this time it appears that Pargas’ wife has not been charged.

The crash at issue occurred on January 11, 2010 in West Palm Beach. Pargas and his wife were driving in a 2005 Ford pickup truck when they were intentionally rear-ended by a 1998 Chevrolet pickup driven by another participant in the scheme. A sheriff’s deputy responding to the scene reported that there were no injuries and that both drivers drove away.

Two days later, however, Pargas was being treated for injuries from the crash at Karow Chiropractic Center in West Palm Beach. The treatment center billed the insurance company $34,065, of which the company paid $19,386.25.

When interviewed by federal agents at his home on April 12, 2012, Pargas admitted to having been recruited by Moya to take part in the scheme. Pargas and his wife were instructed by Moya to undergo treatment at the Karow Chiropractic Center following the crash. They each visited the clinic twice a week, where they reportedly received massages and other treatments. Investigators pieced together their case against Pargas over two years, and he was booked into Palm Beach County Jail on Wednesday on a staged accident fraud charge.

Karow Chiropractic Center’s owner was convicted in April 2014 of conspiracy to commit mail fraud in connection with the staged crash.

Moya was arrested earlier this year by the FBI on separate federal charges of theft of an interstate shipment and selling stolen property after he and an accomplice were caught stealing the contents of a Walmart truck that they were hired to drive to a distribution center. At the time of the trucking theft in early February, Moya was out on bond while awaiting sentencing for his role in the Operation Sledgehammer staged accident fraud, according to an earlier Sun Sentinel article.

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Special Investigation Units Learn the Latest Techniques to Stay Ahead of Fraudsters

The cost of fraud, which has an annual price tag of about $80 billion a year, is substantial to insurers as well as the general public. Special investigation units (SIU) put in place by insurers manage a multitude of ever-changing instances of suspected fraud.

The International Association of Special Investigation Units (IASIU) recently held a seminar and expo on insurance fraud to educate investigators about the latest trends and how to stop fraud by using the hottest tools available. Highlights of the conference were covered by Property Casualty 360° in a recent article.

Investigators, many of whom are former military and law enforcement professionals, learned about these newest scams and what they should look for in identifying them, places to find fraudsters, and how to conduct a thorough investigation.

Highlights in the seminar revealed:

  • Voice print” technology that tracks phone calls made by scammers: This technology can make a voice print, similar to a fingerprint, using biometrics to identify callers. Accents and other disguises to the voice will not defeat this technology.
  • A new database of voice prints: NICE Contact Center Fraud Prevention is creating a database of those voice prints to help insurers track and identify fraudsters who repeatedly file false claims.
  • Social media tools: These go beyond the traditional Google or Bing searches. Anyone using social media leaves a road map for investigators, allowing them to connect the dots between a scammer and his or her friends and associates without ever leaving their desks.
  • Information gleaned from staged car fires: A burned-out vehicle has a story to tell if you know how to read the clues. By learning about the properties of fire, ignition sources, burn patterns, what to look for at a burn scene, what types of evidence can be found, the mistakes that fraudsters frequently make, and reading air velocity and direction, investigators can gather the necessary data to rule out or make a case for fraud.

Although fraudsters often stay ahead of the game by introducing new ways to swindle insurers, investigators are now better equipped to handle what comes their way thanks to innovative technologies and techniques.

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Adjusters Unsure about Questionable Claims Delve into Accident Data

In an earlier FL-PIP Blog post titled “Accident Reconstructionists assist Insurance Adjusters in Uncovering Staged Accidents,” we reported how insurance companies may hire accident reconstructionists to analyze car crash data from police reports, photographs, incident descriptions, and repair records to help determine whether car accident claims are real or if crashes were staged.

A recent article in Property Casualty 360° took a look at common scenarios where accident reconstructionists provide input to insurance adjusters. A summary appears below.

Car Accident Scenario #1

The driver of a vehicle said another car hit him from behind when he was slowing for traffic. The other car did not stop to exchange information.

The claims adjuster, who photographed the damage, was suspicious because he thought the damage looked old, the vehicle had recently been added to the policy, and the claimant received a check a few months earlier on a different vehicle but with a similar story.

The data that the accident reconstructionist researched for the different model years and their variants found that the top of the bumper of these vehicles was always at or below 22 inches. It was also determined that the damage showed no signs of paint transfer. Using this information, the accident reconstructionist was able to definitively conclude that the damage seen on the vehicle did not match the driver’s testimony. The claims adjuster denied the claim in full.

Car Accident Scenario #2

Minor contact between the rear of a Chevrolet Malibu and the front of a Hyundai Elantra was reported with the scuff on the Elantra noted to be consistent with a sliding motion. Further investigation was called in uncovering that the Malibu was in a previous crash severe enough to be sold with a salvage title. No other details, including repair records, were available. The driver of the Malibu claimed that in addition to a small dented area on the right rear corner of the rear bumper cover, there was damage to the Malibu’s trunk area, more prominent on the left side of the vehicle.

The accident reconstructionist had test data run on an Elantra from the same model from a 3-mile-per-hour corner impact test and was able to determine that the damage for the Elantra involved in the incident is consistent with a collision at less than 4.2-miles-per-hour. A Conservation of Momentum analysis was then performed and found that an impact resulting in a Delta-V (the change in velocity of the vehicle from its pre-impact, initial velocity, to its post-impact velocity) of 4.2 miles per hour for the Hyundai Elantra would result in a Delta-V of 3.5 miles per hour for the Chevrolet Malibu.

Test data was obtained from the Insurance Institute for Highway Safety (IIHS) for the Chevrolet Malibu and it was determined that the claim was for more severe damage than was sustained and that the damage was partially in an area that was too far away from the actual point of contact.

It was found that not all of the claimed damages to the Malibu could be attributed to contact from the Elantra, and the insurance company subsequently denied all costs associated with the underlying damages.

Every case is unique, and claims with injuries will be treated differently.

Click on the link to read the full article, “Is that auto accident staged? Here’s how to tell.”

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Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Accident Reconstructionists assist Insurance Adjusters in Uncovering Staged Accidents

In some cases, auto accident claims raise red flags with insurers. The damage reported may be clearly visible and no claim for injury has been made, but adjusters just can’t put their finger on it. Before insurers pay the claim, however, they can bring in an accident reconstructionist to help put the pieces of the puzzle together and hedge against fraud.

According to an article in Property Casualty 360°, accident reconstructionists are investigators familiar with questionable claims such as when the vehicle damage doesn’t match the claimant’s story. Frequently, they do their work based on the claimant’s incident description, police report, repair records, and photographs.

Accident reconstructionists delve into many different aspects of the accident including: comparing the damages to the claimant’s statement of the sequence of events; making sure damages match the police report; and verifying that the damages between the vehicles meet the shape and height of the vehicles involved.

Key to making a conclusion lies in geometry and patterns of the vehicles and the damage they sustained. Photographs of the vehicle, in addition to information about the specific make and model enable accident reconstructionists to obtain the vehicle’s specific damage dimensions for use in their analyses. Even so, every case is different and must be considered independently before reaching a conclusion.

Because the scope of assignments are very specific, accident reconstructionists often can quote a price for their work based on the nature of the claim, available evidence, and whether a verbal update or a written report is required.

Input from accident reconstructionists may be invaluable to insurers. They sift through information and provide the missing data necessary to determine whether an accident was staged or if a claim is fraudulent.

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Filed under Insurance Fraud

Jeff Atwater, Facing Re-Election, Notes Success in Shutting PIP Clinics

Jeff Atwater has served as Florida’s Chief Financial Officer since January 4, 2011, and is up for re-election in November. He recently spoke with the editorial board at The News-Press in Naples about his accomplishments and priorities.

In a wide-ranging interview, Mr. Atwater emphasized Florida’s fight against fraud as an area of success. Some highlights from the interview follow.

“We have worked with sheriffs, the state attorney’s office, the FBI and locally with law enforcement, under the umbrella of financial literacy,” notes Mr. Atwater. “We are beginning to neutralize this. We are shutting PIP clinics and under-the-table transactions.”

Key accomplishments in the state’s continuing battle against fraud over the past three years include:

  • 5,000 insurance fraud arrests
  • 2,000 arrests in PIP fraud cases
  • $129 million in public assistance fraud uncovered

Atwater may run for governor or the U.S. Senate in four years, according to the article. He has served in public office since 1993, when he was elected Vice Mayor of North Palm Beach. He was elected to the House of Representatives in 2000 and the Florida Senate in 2002. In 2008 he was selected to serve as Senate President.

Click on the link to read the full article.

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Filed under Insurance Fraud

Florida’s Third-Party Bad-Faith Laws are Costly to State’s Auto Insurance, Says IRC Study

More than $800 million in additional auto liability claim payments were made in 2013 as a result of Florida’s third party bad-faith lawsuit environment.

Those findings were revealed in a recent study—“Third-Party Bad-Faith in Florida’s Automobile Insurance System”—conducted by the Insurance Research Council (IRC). This translates to an average of $79 in additional claim costs for every insured vehicle in the state.

From 1995 through 2013, Florida experienced a striking increase in the frequency of bodily injury liability claims and a significant jump of 68 percent in average claim payments per insured vehicle, according to the report.

Compare that to other large no-fault states that do not authorize third-party bad-faith lawsuits against insurers, such as New Jersey, New York and Pennsylvania, where notable declines in liability claim frequency and much smaller increases or even declines in claim payments per insured vehicle were found.

A contributing factor in Florida’s growing problem with third-party bad-faith lawsuits is believed to be the “apparent failure of the no-fault system’s tort threshold to limit access to liability reimbursement under most auto insurance policies,” according to the study. Other no-fault states’ systems are designed to limit the number of liability claims that are filed for reimbursement for lost wages and medical costs.

In contrast, Florida’s tort threshold appears not to minimize liability claim frequency. In 2013, Florida’s bodily injury claim frequency rate was not only higher than most tort system states (states without no-fault coverage), but was higher than the U.S. frequency rate for liability claims.

“The virtually unrestricted ability to file a third-party bad-faith lawsuit against an insurance company poses a serious threat to Florida’s auto insurance system,” said Elizabeth A. Sprinkel, CPCU, senior vice president of the IRC. “The possibility of winning large bad-faith settlements and court judgments creates powerful incentives for potential claimants and their attorneys to file auto liability insurance claims that otherwise would not be filed.”

The IRC said that it will be doing more research related to the impact of Florida’s tort threshold and other important aspects of the no-fault system and will publish those findings later this year.

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Filed under Insurance Fraud

Three Jacksonville Residents Charged with PIP fraud

Florida Chief Financial Officer Jeff Atwater recently announced that three Jacksonville residents have been arrested for personal injury protection fraud. The suspects—Yolanda Vargas, Christian Vargas, and Willdelyn Rodgriguez—have each been charged with one count of committing a staged motor vehicle accident and one count of insurance fraud.

A fourth suspect by the name of Felix Vargas, who has not yet been located, is alleged to have recruited the three individuals to participate in the fraud scheme. He is believed to be connected to a New York identity theft ring, as well as to an IRS scam in which he directed payment of others’ tax refunds to himself.

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Filed under Insurance Fraud