Tag Archives: Staged accidents

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

Chiropractor & Receptionist Connected to Operation Sledgehammer Get Prison Sentences

Convicted for their role in a massive insurance fraud ring involving staged accidents in South Florida, two more people were sentenced in Operation Sledgehammer last week.

Chiropractor Lawrence Schechtman from Parkland, whom we reported about on our FL-PIP Guide on December 19 when he pleaded guilty to mail fraud conspiracy and mail fraud, was sentenced to four years and four months in federal prison. In addition to his sentence, he was ordered by U.S. District Judge Kenneth Marra to pay more than $2.4 million in restitution.

According to federal prosecutors, Schechtman worked at clinics in Palm Springs and Miami, where he signed off on treatments for people who fraudulently claimed they were accident victims as part of the staged-accident ring which operated in several counties.

According to a story in the August 8 Sun-Sentinel, the 45-year old Schechtman, who suffers from heart and back problems, was granted a request to serve his confinement at the Federal Medical Center, a medical prison in North Carolina. Judge Marra gave the chiropractor two months to turn himself in and begin serving his term.

Another co-conspirator from Palm Springs was sentenced for her role in Operation Sledgehammer. Sircy Sacerio, also known as Sisi or Sircy Santos, received four years in federal prison by Judge Marra.

Under the terms of her sentence, the Palm Beach Post reported, the 31-year old reception and office assistant must also repay $1,146,824.26 and will have two years of supervised release following her time in prison.

She originally pleaded guilty to one count of conspiracy to commit mail fraud and five counts of mail fraud.

Part of the fraud activity in Operation Sledgehammer, which was recorded by investigators, included co-conspirators damaging vehicles with sledgehammers to give the appearance of a crash. The participants in the staged accidents would then go to clinics involved in the ring to receive bogus treatment which, according to the U.S. Attorney’s Office, brought in millions of dollar to chiropractors on false and fraudulent insurance claims. The scheme began around October 2006 and continued through December 2012.

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

Jacksonville Couple Sentenced in “Family & Friends” PIP Insurance Fraud Ring

A married couple convicted of staging car crashes with family members—as we first reported on our FL-PIP Guide on June 23—was recently sentenced for their involvement in an extensive insurance fraud ring in Duval County.

According to a news release issued by the State Attorney’s Office for the Fourth Judicial Circuit, Jose Alberto Velez, 30, received 74 months in prison for three counts of knowingly participating in an intentional motor vehicle crash and five counts of false insurance claims. His wife, April Rosita Wynn, 23, was sentenced to 48 months in prison for two counts of knowingly participating in an intentional motor vehicle crash and four counts of false insurance claims.

A 2012 investigation by the State Attorney’s Office (SAO) and the Division of Insurance Fraud (DIF) found that Velez and Wynn, who are now married, had been recruiting family members and friends to participate in staged car crashes with them. They would then file Personal Injury Protection (PIP) claims through designated rehabilitation clinics, which provided bogus treatment for the participants’ fictional injuries.

Over the past year-and-a-half, almost 100 individuals have been arrested for their involvement in this insurance fraud scheme. Many have already been sentenced, including one of the ringleaders, David Rodriguez Lopez. He received 15 years in prison on charges of schemes to defraud over $50,000, false insurance claims over $100,000, and knowingly participating in an intentional motor vehicle crash.

Other cases are currently pending.

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Filed under Insurance Fraud

Fraudulent PIP Billings of $80K Lead to Fort Lauderdale Arrests

Three Fort Lauderdale residents—Claudio Boyett, Leslie Sanchez Martinez and Claudia Hoy—were arrested for participating in a staged accident that resulted in the submission of $80,000 in fraudulent PIP claims, according to Florida Chief Financial Officer Jeff Atwater.

The three participants allegedly staged an accident involving a U-Haul truck, which hit a parked Dodge Caravan carrying eight occupants. Fraudulent claims were then filed with multiple clinics across South Florida. More arrests are expected in the case.

In other PIP fraud news across the state, David Torres was convicted for his work as a recruiter on behalf of the Indian Rehabilitation Center in Jacksonville. He was charged with eight counts involving a staged accident. Torres was ordered to repay $109,000 in restitution to eight insurance companies, and will serve five years in jail.

“PIP fraud schemes drive up auto insurance rates for all Floridians, which is why we are working day and night to prevent it from happening in the future and hold the fraudsters who have broken the law accountable,” said CFO Atwater.

The Florida Department of Financial Services reports that it has made almost 2,000 PIP fraud arrests since early 2011. Convictions are up 17% for the current fiscal year, with a total of 1,225 to date.

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Filed under Insurance Fraud

“Family & Friends” Staged Accident Ring Uncovered in Duval County

A couple faces 20 years in prison as a result of their participation in a PIP insurance fraud scheme which involved staging a car accident, and subsequently collecting money from the false insurance claims they filed.

Jose Alberto Velez, 30, and April Rosita Wynn, 23, were both convicted of knowingly participating in an intentional motor vehicle crash and four counts of false insurance claims, according to a news release issued by the Office of the State Attorney for the Fourth Judicial Circuit of Florida.

Their convictions stem from a staged car crash that happened in May 2012, the same year that the State Attorney’s Office (SAO) and the Division of Insurance Fraud (DIF) began investigating a series of questionable car accidents in Duval County.

Their investigation uncovered a larger Personal Injury Protection (PIP) insurance fraud scheme where nearly 100 individuals have been arrested over the past 18 months.

It was discovered that Velez and Wynn, who are now married, persuaded family and friends to participate in their staged car crashes. After the accidents, Velez, Wynn and their accomplices would go to designated rehabilitation clinics that would provide mock therapy for fictional injuries, and then file PIP claims through those clinics.

One of the ringleaders of the scheme, David Rodriguez Lopez, was sentenced to 15 years on charges of schemes to defraud over $50,000, false insurance claims over $100,000, and knowingly participating in an intentional motor vehicle crash. Other cases resulting from the investigation are currently pending.

Besides their present charges, Velez and Wynn are still awaiting other charges for allegedly staging additional accidents. They will be sentenced the week of July 28.

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Filed under Insurance Fraud

Three Arrests Made in Connection to a Fort Lauderdale Staged Auto Crash

Three people in Fort Lauderdale have been arrested for their involvement in staging an auto accident in a church parking lot in order to collect $80,000 from an insurance company, a June 19 article in the Sun Sentinel said.

According to police records, Claudio Boyett, 44, Leslie Martinez, 45, and Claudia Hoy, 31, all of Fort Lauderdale, are accused of grand theft and insurance fraud. Boyett was arrested earlier this week while the other two were arrested last week.

A report from Florida’s Division of Insurance Fraud showed a U-Haul truck struck a Dodge Caravan in the parking lot of the Pare De Sufrir Church on August 7, 2012. Martinez was driving the Caravan, which had Hoy and six others as passengers. Boyett struck the van with the U-Haul he was driving, the report said.

After the accident, Martinez, Hoy and Boyett allegedly went for medical treatment and filed a personal injury protection claim with United Auto Insurance worth $80,000, according to insurance company investigators.

Officials from the insurance company said investigators found that one witness was offered $1,500 for the use of her Caravan; another acknowledged the accident was staged.

These arrests have come as a result of Operation Sledgehammer, the effort between the FBI and state authorities which launched three years ago to crack down on insurance fraud from staged auto accidents.

According to the story, investigators have found almost $20 million in illegal payouts and have charged almost 100 people in Broward, Palm Beach and Miami-Dade counties. Also, $5 million in restitution has been ordered to be paid back to insurers by some of those convicted.

These types of efforts have been making an impact in Florida, according to a study by the nonprofit National Insurance Crime Bureau. The organization has found fraudulent claims from staged crashes have actually been falling since Florida’s PIP reform has been enacted in the past two years, as our FL-PIP Blog reported in March.

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Filed under Insurance Fraud