What You Need to Know About Fraud

Most states across the nation require drivers to carry car insurance in order to drive legally. This is to help protect all drivers on the road should they get into an accident.

It’s important for your own safety, but there is another danger: fraud. It’s not just a one-way street either. Both drivers and companies can commit car insurance fraud. Drivers can also be the victims of auto accident scams in some cities, organized and otherwise.

To help prepare you for dealing with this, we’ve put together this comprehensive guide to help you both avoid committing car insurance fraud, as well as to avoid having car insurance fraud committed against you.

We’ll cover such topics as what car insurance is, a basic rundown of what car insurance is, the various types of car insurance fraud, specific state laws regarding car insurance fraud, and more.

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What is Car Insurance Fraud?

We’ll kick off this guide by discussing what car insurance fraud is.

According to the National Association of Insurance Commissioners (NAIC), insurance fraud can be defined in the following way:

” Insurance fraud occurs when an insurance company, agent, adjuster or consumer commits a deliberate deception in order to obtain an illegitimate gain.”

What does this mean? Essentially it’s any time someone tries to gain something (monetary, benefits, etc.) that they are not rightfully entitled to.

Who exactly can commit insurance fraud? Well, any number of individuals can commit insurance fraud, but it is most commonly committed by the following individuals according to the DMV:

• The policyholder (you)
• Another driver
• A repair person
• A medical professional

So how do you protect yourself, or prevent yourself, from being affected by car insurance fraud?

Keep reading to find out more.

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Why Would Someone Commit Insurance Fraud?

There are a number of reasons why someone would commit insurance fraud, but in this section, we’ll touch on just a few common reasons.

Higher Rates

One common reason individuals will commit car insurance fraud is for protection against higher insurance rates. If an individual already has a good number of accidents/traffic violations on their driving record, chances are that they are already paying decently high insurance rates.

These individuals will then fabricate their records, known as rate avoidance or premium fraud, to get lower rates from their insurance provider.

Premiums Increasing

Another common reason is due to the fear of premiums increasing.

A lot of times, once you have gotten into an accident or have a particular kind of traffic violation on your record (such as a DUI), your insurance provider will raise your insurance rates.

This is due to the fact that they now consider you a higher-risk driver than previously, and adjust your rates. Therefore to avoid these higher rates, some individuals will fabricate the details of the accident/traffic violation to avoid having to pay higher rates.

Not Getting Coverage

Not being able to get coverage is another common reason.

Although there are plenty of options for getting insurance coverage (even for high-risk drivers), some individuals will commit insurance fraud by fabricating their driving record so that they are able to get insurance coverage.

This also ties in a lot with higher rates, as a lot of insurance providers will provide insurance coverage for high-risk drivers, but at much higher rates than normal.

Financial Gain

Sometimes, the motivation is simple greed. They want money from the insurance company. So they commit fraud to get it. Some might see lying about fault in an accident to avoid paying a deductible as being under this umbrella as well. In some cases, an accident did occur causing the insurance claim. In others, one or more parties are making false claims altogether.

Types of Car Insurance Fraud

There are many different types of car insurance fraud, so we would like to break it down for you to help give you a better understanding of each type.

Hard Versus Soft Fraud

When it comes to car insurance fraud, there are two main classifications; hard fraud versus soft fraud.

Hard insurance fraud is defined by the DMV as:

“When someone intentionally causes an incident that allows him to file an auto insurance fraud claim.” What exactly does this mean?

Well, let’s say you are driving down the road and another driver pulls in front of you. They intentionally slow down so that your car is closer to the back of theirs, and then suddenly slam on their breaks. Due to the lack of space and time to avoid the vehicle, you then slam into the back of their vehicle.

If this person were then to accuse you of causing injury to them and seek damages, that person has then committed hard insurance fraud. Of course, these types of cases happen all the time, and they are notoriously difficult to prosecute. If you rear end someone, many states would say you were following too close regardless of the other circumstances. Whether they’re brake checking you on the freeway or getting in front of you and braking to cause an accident, it’s hard to prove they didn’t have an obstacle or other reason to stop more suddenly.

A different example of this would be if someone were to purposefully remove items from their vehicle and claim that the vehicle had been broken into and their items had been stolen, this would also be considered hard fraud.

Soft insurance fraud is defined by the DMV as:

“When legitimate claims are distorted or there are other lies made for financial benefit.”

This means that if you actually had a legitimate claim to make but decided that you wanted to (for example) add additional fabricated details, you will have then committed soft fraud.

Additionally, let’s say that you were in an accident and your car was taken into a car repair shop.

The shop decides that they are going to charge your car insurance company a high price while putting in cheap or counterfeit replacement parts. This would be considered soft fraud on the part of the car repair shop.

A second example would be if you were in an accident that caused minor damage. Then the other driver claims other pre-existing damage was also caused by your accident. That would be soft fraud.

What Else Should You Know about Bodily Injury Insurance Fraud?

There are so many different types of fraud, but in this section, we’ll cover some of the types of fraud that involves your insurance coverage and insurance rates.

Bodily Injury Claims

Bodily Injury Coverage, depending on what state you reside in, is considered part of the minimum liability coverage that is required for most states.

What exactly is this coverage type?

Bodily Injury Coverage helps to cover injuries caused to another driver in an accident that you were to cause.

If you were the one responsible for an accident, and you live in an “at-fault” state, you and your insurance provider would be the ones responsible for paying for those injuries the other driver incurred.

So how do people commit fraud through bodily injury claims?

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How Do People Commit Fraud through Bodily Injury Claims?

According to the Coalition Against Insurance Fraud, it is the “unneeded treatment of phantom injuries. Usually, these are bogus soft-tissue injuries such as sore backs or whiplash, which are difficult to medically identify and dispute.”

This type of fraud alone has cost approximately $5.6 billion-$7.7 billion in losses.

You’ve likely seen some of the more hilarious attempts at this type of fraud, as seen in the video below.

https://www.youtube.com/watch?v=09MK6qLPWOg

 Medical Expenses

Medical Expense Coverage is similar to Bodily Injury Coverage, but instead of it paying for another driver, it pays for your own medical expenses should you ever be involved in an accident.

These claims have increased over the past few decades, although the severity of the “injuries” has decreased according to the Coalition Against Insurance Fraud (CAF).

Premium Rating Fraud

We mentioned this type of fraud in an earlier section on some of the common reasons why people commit car insurance fraud.

This is where an individual fabricates their driving record or lies on their insurance application/renewal.

This type of fraud accounts for “nearly 10 percent of the $161.7 billion in personal auto premiums written.” Of course, with everything being online, this type of fraud is harder to commit. Insurance companies can check your driving history in minutes.

 Suspicious Claims

Suspicious Claims are more of the catch-all phrase for other fraudulent coverage and rate fraud types.

This encompasses some of the more common types of car insurance fraud committed such as staging an accident, vehicle dumping, false registration, and more.

These types of fraudulent claims are considered suspicious typically due to the nature of the circumstances.

For instance, the example we mentioned earlier for hard fraud, about the driver stopping in front of you in order to purposefully get you to hit them, would be a suspicious claim.

We’ll discuss these types of fraud further in the next section.

What Are The Most Common Ways of Committing Car Insurance Fraud?

Now that we’ve covered some of the different types of car insurance fraud, we’ll discuss a few of the more common ways in which these types of fraud are committed such as:

• Staged Accidents
• Vehicle Dumping
• False Registration

Staged Accidents

This is a type of hard fraud where a driver purposefully “stages” an accident. It’s considered one of the most dangerous types of fraud as it can cause real injuries and even deaths. In this case, one party plans the accident, and the other is typically victim to it, unaware of what has really happened.

According to the National Insurance Crime Bureau (NICB), this can happen in the following ways:

• Drive Down: Also known as “the wave”, this is when you are trying to merge into traffic and are signaled by another driver that you can merge ahead of them. Then when you are attempting to merge,  the other driver then speeds up and causes a collision.
• Panic Stop: The panic stop occurs when another driver pulls in front of your vehicle, and a backseat passenger in the other vehicle alerts the other driver when you have become distracted by something. The other driver then slams on the brakes and causes you to rear-end their vehicle.
• Side Swipe: This type of staging accident typically occurs at a busy intersection with dual left-turn lanes. The other driver positions their vehicle in the other lane and then side swipes the car in the inner left-turn lane.
• Swoop-and-Squat:
  • On an ordinary city street: This typically involves three vehicles, two driven by the other fraudulent drivers and the third by you. The driver of the “squat” vehicle pulls in front of the victim’s car. The driver of the “swoop” vehicle pulls in front of the squat vehicle, causing the driver of the squat vehicle to hit his brakes. The victim cannot react in time and rear-ends the squat vehicle. The swoop vehicle races off and is not seen again. The victim then typically is responsible for any vehicle damage and personal injury to passengers in the squat vehicle.
  • On a freeway or expressway: Similar to the above, but four vehicles are typically involved, with three belonging to criminals. In this variation, the third criminal boxes in the victim so he cannot change lanes when the swoop vehicle cuts off the squat vehicle. Following the crash, the swoop and box-in cars speed off, again forcing the victim’s insurer to pay the claim.
  • Vehicle Dumping

What Is Vehicle Dumping?

ehicle dumping is when an individual does something to dispose of their vehicle and claiming that it was stolen.

Vehicle dumping can be done in any of the following ways:

• Leaving it somewhere
• Burning/Destroying it
• Dumping it in a lake/ocean
• Selling it

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What Is False Registration?

As you probably know, where you live can affect what kind of insurance premiums you will pay. Things such as the particular region demographics, per capita disposable income, and other various factors can determine what you’ll pay.

False registration fraud occurs when someone who registers their vehicle for an area that has lower insurance premiums.

This is pretty common amongst those who live in more expensive areas. They have a family member or friend living in a cheaper area. So they claim to live in their house or apartment.

What Are The Laws Against Insurance Fraud?

Car insurance fraud is an illegal act across the nation, and as such, there are many laws you’ll want to know about so that you don’t find yourself in trouble.

Fault-Based System

As we mentioned in an earlier section, states fall under either an “at-fault” or “no-fault” system.

 

An “at-fault” system is where the driver who is at fault for the accident is the one held liable for injuries/damages incurred during that accident.

A “no-fault” system is where regardless of who is responsible for the accident, each driver will need to depend on their own insurance company to pay for any injuries/damages incurred during the accident. The insurance company for the at-fault driver would compensate the other party’s insurance company. The insurance company would have the right to sue if applicable.

Car insurance fraud, according to the Information Insurance Institute (III), is most prevalent in “no-fault” states. Of which, there are three specific kinds of systems:

• Choice no-fault: In choice no-fault states, drivers may select one of two options: a no-fault auto insurance policy or a traditional tort liability policy. In New Jersey and Pennsylvania, the no-fault option has a verbal threshold. In Kentucky, there is a monetary threshold.
• Tort liability: In traditional tort liability states, there are no restrictions on lawsuits. A policyholder at fault in a car crash can be sued by the other driver and by the other driver’s passengers for the pain and suffering the accident caused as well as for out-of-pocket expenses such as medical costs.
• Add-on: In add-on states, drivers receive compensation from their own insurance company as they do in no-fault states, but there are no restrictions on lawsuits. The term “add-on” is used because in these states first-party benefits have been added on to the traditional tort liability system. In add-on states, first-party coverage may not be mandatory, and the benefits may be lower than in true no-fault states.

Read more: What’s the Difference: No-Fault vs. Tort Car Insurance

But why would this type of system be more prevalent for car insurance fraud?

Well, according to the Information Insurance Institute (III):

“… In many no-fault states, unscrupulous medical providers, attorneys and others perpetrate fraud by padding costs associated with a legitimate claim, for example by billing an insurer for a medical procedure that was not performed.”

Which states in the nation follow this “no-fault” system?

• Florida
• Hawaii
• Kansas
• Kentucky
• Massachusetts
• Michigan
• Minnesota
• New Jersey
• New York
• North Dakota
• Pennsylvania
• Utah
• Puerto Rico

 Hotspot Car Insurance Fraud States

In this section, we’ve gathered some interesting facts and statistics about some of the hotspot states for auto insurance fraud from the Coalition Against Insurance Fraud.

Florida:

• According to the Florida Office of Insurance Regulation, no-fault auto-insurance reforms (HB 119) enacted in 2012 helped to reduce fraud and lower PIP premiums by approximately 13.6 percent.
• On average, no-fault fraud/abuse costs consumers and insurers about $658 million in 2011 in Florida alone.
• Due to the abuse/fraud of Florida’s no-fault system, according to the Insurance Information Institute (III), the average two-car family in Florida pays nearly $100 MORE in auto premiums than most other states.

Michigan:

• According to the Insurance Alliance of Michigan (June 2017), more than 70 percent of Michigan voters support reforming the state’s no-fault system.
• The Insurance Alliance of Michigan also found that 87 percent Michigan voters also support cracking down on insurance fraud and scams by requiring people to provide proof that they were injured in a car crash, such as a police report or information from a doctor about specific injuries.

New York:

• Claimed losses for medical expenses, lost wages and other expenses related to injuries from auto crashes in the New York City area have risen 70 percent over the past decade. This surpasses the 49-percent increase in medical-care inflation over the same period.
• Nearly one in four claims (23 percent) involved the appearance of claim abuse fraud, material misrepresenting of facts, or buildup.
• Claims from the New York City metro area were more than four times as likely to involve apparent abuse (35 percent v. 8 percent for the rest of the state).
• According to the Insurance Research Council (November 2011), more than half of apparently abusive claims (52 percent) stemmed from accidents in Brooklyn or Queens.

California:

• The state fraud bureau received 17,981 suspected fraudulent claims in FY 2012-13, assigned 721 new cases, made 401 arrests, and referred 304 submissions to prosecuting authorities. The potential loss amounted to $120.1 million.
• The fraud bureau assigned 231 new cases and made 222 arrests and 172 referrals to prosecuting authorities involving organized automobile activity in major urban areas. Potential loss amounted to $5.1 million.
• The California Department of Insurance found that district attorneys receiving grants in 10 counties prosecuted 204 cases involving organized automobile fraud activity. They included 448 defendants with chargeable fraud totaling $8.3 million. District attorney prosecution resulted in 180 convictions.

Massachusetts:

• Massachusetts launched task forces in 13 communities against widespread staged-crash rings amid public outcry after 65-year-old grandmother Altagracia Arias died in a setup crash in 2003.
• Drivers in the 13 communities have saved $875 in auto premiums per year.
• Drivers in Lawrence county, known as the “worst hotbed of fraudulent claims”, have saved more than $68 million.
• Larger chiropractors in Lawrence county have decreased in both clinic counts and billings by up to 90 percent. High-volume physical therapy clinics (billings exceeding $100,000 annually) have been eliminated, and attorney involvement in PIP claims has dropped; and
• According to the Insurance Fraud Bureau of Massachusetts, staged accidents in Massachusetts have been reduced dramatically as people around the state (who used to be involved in fraudulent activities) have taken notice of the crackdown and altered their activities.

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You’re Not The Only One Who Commits Insurance Fraud

We know, shocking right? But drivers aren’t the only ones who commit insurance fraud. Car insurance fraud can be committed by other entities such as car insurers, repair shops, physicians, and attorneys.

In this section, we’ll break down each of these to give you a better idea about these types of scams.

How Insurers Can Commit Fraud

We would all like to think that we do business with insurance companies who want to best protect us and provide the optimal coverage but unfortunately, not all companies are as honest.

According to the National Association of Insurance Commissioners (NAIC):

“Fake insurance companies and dishonest insurance agents can defraud consumers by collecting premiums for bogus policies with no intention or ability to pay claims.

These “companies” may offer policies at costs that are significantly lower than the traditional market price in order to woo consumers who are trying to save money.

In many cases, a fake insurance company will provide consumers with documents that look real. In other instances, these policies may even be represented by legitimate insurance agents who themselves have been misled by fraudulent companies.”

They also state that these are some of the warning signs that an insurance provider is attempting to commit insurance fraud with you:

• If an agent or broker is very aggressive and pressures a consumer by saying they must sign up for a policy right away (sometimes adding…or the premiums will go up).
• The premiums from one company are a lot lower (more than 15-20% less) than other companies’ comparable coverage.
• When a consumer tries to call the insurer to get more details or ask a question, they can’t find a listed phone number, or it is very difficult to get through on the phone.

In addition, make sure to be aware of some of the following common car insurance insurer scams according to the Coalition Against Insurance Fraud:

• Stealing your premiums: When an agent pockets your insurance premiums instead of sending it to the insurer.
• Selling phony insurance. When an agent or company rep sells you fake coverage from a phony insurance company.
• Selling coverage you don’t want or need. When the coverage is real, but it’s expensive, unnecessary, and your current policy may already cover that risk.
• Sliding: When an agent or insurer slips you extra coverage you didn’t ask for, but do pay for.
• Twisting: When an agent may urge you to change policies prematurely by “twisting” the truth about the downside.

If you feel like you are experiencing any of these, you can refer down to the section at the end of this guide on how to report insurance fraud.

How Repair Shops Can Commit Fraud

This type of insurance fraud committer might be surprising, but it does happen.

But how could a repair shop even commit insurance fraud? Well, there are actually a few common ways that this can happen:

• Exaggerating the repair cost of your vehicle after an accident.
• Faulty air bag replacement by either not actually replacing your air bag at all or by putting in other objects to fill the space.
• Faulty windshield replacement

So making sure that you take your car to a reputable car repair shop when you need to repair your vehicle will be critical to avoiding scams like this.

How Physicians Can Commit Fraud

Yes, even your DOCTOR can commit car insurance fraud! Crazy right?

This happens typically through fraudulent medical claims after you’ve been in an accident and have seen them for your medical issues.

Just like with repair shops, there are several ways in which a physician could commit insurance fraud:

• Phantom/Unneeded treatments:When a physician/medical provider bills your auto/health insurers for expensive treatments, tests or equipment that you never actually received OR for illnesses /injuries you never had. Reversely, this would also apply for giving you dangerous or life-threatening treatment that you don’t need.
• Double billing: When a physician/medical provider double/triple bills your insurers for the same treatments in the hopes that the insurer won’t discover the multiple bills.
• Poor care: When a physician/medical provider provides you with poor or sub-par treatment for real and urgent medical problems.
• Rolling labs: When a mobile diagnostic lab gives needless or fake tests or physical exams and then bill health insurers for expensive procedures.

This is a particularly dangerous individual to commit car insurance fraud, as this has the most to do with your own health! So if you feel like your physician/medical provider is doing any of the above, make sure that you get a second opinion at the very least!

Car Insurance Fraud and You

Now that you have a better understanding of what car insurance fraud is, in this final section, we’ll discuss topics such as ways in which you can protect yourself from car insurance fraud, how car insurance fraud directly affects your policy, and how to report car insurance fraud.

 Protect Yourself from Car Insurance Fraud

With all of these various ways in which car insurance fraud can be committed, you’re going to want to protect yourself!

Below are some recommended ways to help keep yourself safe from car insurance fraud according to the Coalition Against Insurance Fraud:

• Make sure the agent and company are licensed in your state. Be especially careful if you don’t recognize the company’s name. Contact your state insurance department, which issues licenses.
• Call your Better Business Bureau or local consumer assistance agency to see if the agent has complaints filed against them. Check to see how many complaints have been filed against an insurance company in your state.
• Back off if the agent offers coverage whose price is 30-50 percent lower than competitors. Shop around to find out the normal price range.
• Always pay your premiums by check or money order. In most cases, make it payable to the insurance company, not the agent or agency. Be sure to get a receipt. Photocopy your check or money order for your records.
• Think twice if the agent insists you pay in cash or tries to sell coverage in unusual situations such as in a restaurant or bar.
• Be suspicious if your agent bills you for premium installments after your first payment. Normally your insurance company or premium finance company handles the billing.
• Buy coverage only after all documents are completely filled out, you fully understand what coverage is included, and what the cost for each coverage is. Make sure your agent clearly explains all.
• Go slow if the agent or company rep seems evasive or can’t answer your questions, or tries to sell you coverage without “bothering” your family with the details.
• Never sign a blank insurance form or give your agent power of attorney to sign an insurance application or buy coverage for you.
• Get a copy of every form you sign. If you finance your premiums, make sure your agent gives you paperwork that describes exactly how much you pay for each installment, and what that payment covers.
• Watch out if the sales pitch highlights the surrender and use of cash values in older life coverage to buy new higher-valued policies.
• Contact the company if you haven’t received a policy within 60 days after sending in your application.
• Get a second opinion if an agent tries to sell you new and more expensive coverage even though you still have a current policy in effect. Talk to your financial advisor or another agent. Ask the selling agent direct questions, and get the answers in writing: Why do you need this coverage? What are the benefits? Exactly what’s covered? How much will it cost?
• Know what your current policy does and doesn’t cover. Ask your agent or insurer for a detailed explanation in plain language. Ask pointed questions if you have any doubts about what’s in your policy.

Make sure your insurance company is healthy and can pay claims especially if it’s an unfamiliar name. Contact A.M. Best or Moody’s to see if the company is financially healthy. Call your state insurance department to make sure it’s licensed in your state.

 How Car Insurance Fraud Can Affect Your Policy

The direct effect of car insurance fraud is that it tends to drive up the amount that insurance companies must pay in claims. In turn, this then means that it drives up the amount of money that you pay for your car insurance premium.

Regardless of whether you committed the crime or not, this is the indirect result of insurance fraud for all drivers across the nation!

Additional factors of this that will affect your policy is that if you were to be the one who committed car insurance fraud, you would likely not have an easy time finding insurance coverage afterward, as companies wouldn’t be willing to offer you coverage.

 

In summary, committing car insurance fraud is simply not worth it.

 Reporting Insurance Fraud

If you, or someone you know, would like to report insurance fraud, please refer to the tables down below.

In addition, if you suspect fraud activities in a state like Washington, D.C., you can directly contact the National Insurance Crime Bureau (NICB) in the following ways. All tips can be anonymous:

1. Call 800.TEL.NICB (800.835.6422) – Monday through Friday 7 a.m. to 7 p.m. CST.
2. Report fraud online using the form

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