1 NOT ALL AUTOMOBILE COLLISIONS ARE ACCIDENTS Auto Insurance Rates Keep Rising Honest Americans are getting their pockets picked every day and most don t even realize it. Bankers, laborers, truck drivers, and even police officers are being taken for a ride by insurance fraud scam artists, who are taking your insurance dollars and threatening your life. The scams are called staged automobile accidents. However, the collisions are far from being accidental. With the right circumstances, the schemer intentionally collides into the victim s car. Adding insult to injury, the victim is often found at fault. As a result, the victim is held accountable for injuries to the suspect s passengers and repairs to the suspect s vehicle. The schemer often cons the police, paramedics, and even doctors to obtain documents to legitimize their accident claims. In some cases, the staged collisions involve stolen vehicles and organized rings that orchestrate the collisions by giving the players scripts. COMMON TYPES OF STAGED AUTO COLLISIONS Swoop and Squat Without notice, the vehicle in front of you stops abruptly, and you find yourself the responsible party in a rear-end collision. Yet this is no accident. The other driver planned the accident and expects to submit a vehicle damage and personal injury claim against you insurance carrier. Drive Down Occurs when a victim tries to merge into traffic. The stager yields, waving to the victim to proceed. As the victim begins to merge, the stagers intentionally smash into the victim, claiming that they never waved. Hit and Run The suspects use a previously damaged and insured vehicle and claim they were the victims of a hit and run. They often steal vehicles to crash and abandon at the scene of the hit and run. Side Swipe With the side swipe, perpetrators target innocent drivers in a dual left turn lane of a busy intersection. If an unsuspecting victim in the inner lane drifts into the outer lane, the perpetrators intentionally force a collision.
2 Paper Accidents A vehicle owner fabricates an accident on insurance reports to cover existing or non-existent damage and collect an insurance payment. Accidents with Rental Cars A criminal rents a car to be used as the at fault vehicle. He is sure to purchase the Collision Damage Waiver (CDW) with the rental agreement so as to ensure that all damages will be covered by the rental company s insurer. The driver then reports that the rental car was damaged in an accident with a late model, expensive car. This expensive car actually belongs to the criminal and has extensive pre-existing damage. INDICATORS OF POSSIBLE STAGED COLLISIONS Over the counter police traffic reports Adding additional passengers to a traffic report Three or more unrelated occupants in a vehicle Insured driver eager to take blame Rental vehicle with collision damage waiver Collision shortly after insurance policy obtained Little or no description of suspect causing collision Injury claims in excess of minor damage to vehicles Occupants listing P.O. Box for address WHAT CAN YOU DO TO HELP? Document Facts If no police report is taken, you can still document facts, occupants, etc. Give the information to both parties in the collision If you suspect a staged collision, notify your traffic follow-up investigators and the National Insurance Crime Bureau at TEL-NICB ( ) SOME INVESTIGATIVE TIPS Insist upon actually inspecting all the vehicles involved in a claim. When inspecting the vehicles, make sure the actual damage on each vehicle corresponds to the damage reported. Note any unrelated damage. Know all of the facts of the accident upon which the claim is based. If there are any discrepancies in the reported information, verify the information with the appropriate sources (i.e. questions concerning the registration or title can be directed to the Department of Motor Vehicles). Require proof of identity such as a driver s license with photo and proof of registration. Verify all documents are current as expired vehicle registrations may reveal that a vehicle is being used only for claims purposes. Report all suspicious claims to NICB.
3 THE PROBLEM Staged vehicle collisions are a major contributor to the $30 billion property-casualty insurance fraud problem. Honest policyholders ultimately pay for this scam in increased insurance rates. THE PROCESS Staged vehicle collision participants orchestrate vehicle collisions involving unsuspecting motorists and then team up with dishonest doctors, lawyers and auto repair shop operators, who inflate injuries and damage caused by these accidents. Bogus witnesses are positioned near the caused collision to support the criminal s account and contradict the innocent driver s testimony. In many instances, criminals inflict injury upon themselves, or claim hard-todispute soft-tissue injuries in order to collect on insurance claims. HOT TARGETS Favorite targets for staged collisions are fully insured drivers not accompanied by passengers who could serve as witnesses. Luxury cars are often targeted because they offer the promise of extensive insurance coverage. NICB FACT The big profiteers in most staged collisions are the professionals involved who typically receive the majority of each claim. In most scenarios, the cooperating passengers receive the smallest payout. SEVEN STEPS OF A STAGED AUTO COLLISION 1. Ring leader is typically a corrupt attorney or doctor who hires a capper a street level collision coordinator. 2. The capper recruits passengers promising financial rewards. 3. All players script the details of the collision and injuries 4. Orchestrate accident 5. Capper refers cooperating passengers to an unethical attorney for legal representation. 6. Lawyer directs passengers to a crooked medical provider who inflates medical billing for often nonexistent injuries. 7. Attorney negotiates a settlement with the insurer for the cooperating victims. Ring members divide the claim payment; the crooked professionals usually received the largest share. INSURANCE FRAUD: THE $30 BILLION DISASTER Billions of dollars are picked from American pockets each year by what many people consider a victimless crime. Most people don t even know it is happening. This thievery is not occurring on the streets of urban America. Rather, it is happening in automobile repair centers, medical clinics, law offices and even the next-door neighbor s house. Often white-collar criminals, including doctors and lawyers, have the quickest hands.
4 THE CRIME IS INSURANCE FRAUD How serious is the insurance fraud problem? Insurance fraud is one of the most costly white-collar crimes in America, ranking second to tax evasion. To the insurance industry, insurance fraud has destructive capabilities that exceed even Hurricane Katrina, the costliest disaster in United States history. The National Insurance Crime Bureau (NICB) estimates that property/casualty-based insurance fraud costs Americans $30 billion annually. In contrast, Hurricane Katrina s devastation resulted in $41 billion of damage. Adding other insurance lines to the equation, like health, life and specialty insurance, the total cost of insurance fraud may exceed $100 billion per year. According to the NICB, 10 percent of property/casualty insurance claims are fraudulent. WHO PAYS FOR INSURANCE FRAUD? Insurance companies, policyholders, taxpayers and the general public pickup the tab through increased insurance rates, higher taxes and inflated prices for consumer goods and services. WHO COMMITS INSURANCE FRAUD? Unlike the great western movies from yesteryear, insurance fraud perpetrators are not as easily identifiable as bank robbers and stagecoach bandits. They carry no masks, guns or safe cracking equipment. As the following NICB investigations revealed insurance fraud perpetrators can be members of complex organized fraud rings or the next door neighbor looking for a second income. ORGANIZED FRAUD RINGS Three generations of the Bailog family pled guilty in Chicago for defrauding insurance companies of more than $750,000 in dozens of staged car accidents and thefts, faked falls and bogus homeowner injury claims and burglaries. Prosecutors say the Bailogs intentionally drove cars into poles at low speeds, drew blood from syringes and spread the blood on their mouths and noses. Days later, when they went to plead their cases with insurance adjusters, the stuffed cotton up their noses and in their mouths to appear swollen and put on makeup to look bruised. To make the faked slip-and-fall accidents appear genuine, prosecutors say, they cut their noses with razor blades. One defendant, who suffered a compression fracture of his vertebrae in the early 1980s, claimed to have sustained the same injury in at least 17 other incidents in the 1990s. The ring even had their own home-cooked fake vomit to slip on made from potatoes and salad dressing. WHITE-COLLAR PROFESSIONAL An 18 months sting operation resulted in a grand jury indictment of seven medical doctors, one chiropractor and 12 health care workers on charges of offering kickbacks or falsifying insurance claims. According to court documents, nine clinics billed nearly $60,000 for limited or nonexistent patient care. Six clinics diagnosed investigators posing as patients as having soft-tissue injuries, even though all of the
5 undercover investigators were physically fit. In a few cases, the undercover investigators were coached on what to say if asked about their treatments. AUTO REPAIR SHOPS Five people working out a Los Angeles-area auto body shop were suspected of filing 40 bogus insurance claims worth a total of $300,000 for hit-and-run damage to vehicles they owned. They used these vehicles to stage several accidents after insuring them through multiple carriers. Insurance records indicated that most of the repairs were performed by one Los Angeles body shop. NICB and California Department of Insurance investigators identified the fraud when they determined that most of the claims were identical, with all vehicles sustaining the same damage, and all accidents lacking witnesses. THE NEXT-DOOR NEIGHBORS Challenging the stereotype that fraud criminals are either thugs or white-collar bureaucrats, one Connecticut couple provided a textbook example of how to turn a hobby (collecting insurance policies) into a profitable and illegal sideline business. This Hartford family the husband, a plumber and the wife, a school psychologist appeared a picture of stability, complete with a five-year old son and a nice suburban home. Yet as the Hartford Courant reported, they used their multiple policies to stage the largest insurance fraud scheme in Connecticut history. Following a two-year investigation, the couple was arrested and charged with staging phony accidents and homeowners claims that cost 19 insurance companies more than $300,000. The NICB assisted the case by identifying suspicious claims submitted by member insurance companies. Ironically, the couple s son aided the investigation. His father pleaded ignorance when inspectors from the State Attorney s office found several parts from a Mercedes-Benz in the attic, but the boy volunteered that My Daddy put those up there. The parts are believed to be a 1979 vehicle involved in several bogus claims. NICB INVESTIGATIVE SERVICES Our Investigative Services are separated into several specific areas: To be the liaison between our member companies and law enforcement. To focus on interdiction and repatriation of stolen vehicles. To focus on multi-claim and multi-carrier investigations with an increased of case management as it relates to those cases with a national status. This is accomplished by our agents who are located throughout the US, Mexico, Panama and Puerto Rico. Our Mission: To lead a united effort of insurers, law enforcement agencies and representatives of the public to prevent and combat insurance fraud and crime through data analytics, investigations, training, legislative advocacy and public awareness. Our agents respond to law enforcement when they notify us of individuals they are investigating who have questionable insurance dealings.
6 Vehicle thieves are responsible for more than 200,000 vehicles being stolen and illegally exported yearly. Some of these vehicles are chopped up for parts and some are being cloned. Corrupt businesses such as chop shops are being targeted for investigations to stop this type of practice. Finally, export fraud and interdiction/repatriation are some of our highest priorities. By placing personnel at the top 50 land and seaports, we hope to stop the flow of stolen vehicles from our borders. Our Resources: The NICB has many investigative resources that you can utilize: Our Special Agents located throughout the US and other countries. Our contingent of Investigative Assistants - there to assist you with information on Vehicles. (NCIC records, shipping records, etc). Our Document Analyzer - analyzes and detects altered documents that are sent to us for investigation. The Document Analyzer reads through white-outs, black-outs and erasures. It can identify security fibers in such documents as car titles. Current data for the Document Analyzer shows about a $10,000 savings per claim. Our telephone hotline is in service, It is answered by a real person who has a script of questions designed by the NICB to elicit pertinent information identifying the claim so the appropriate carrier can be notified so they can investigate questionable claims. The hotline receives approximately 5,000 calls a year. Data Analytics: Strategic Intelligence is concerned with existing patterns or trends of insurance crime activity, while Tactical Intelligence is concerned with a specific event or investigation. NICB has 23 analysts located at our headquarters offices and in the field in our 8 area offices. The Field Analysts are involved with both strategic and tactical intelligence gathering. The analysts who are assigned to headquarters work either with the Tactical Case Enhancement unit or the Strategic Group Analysts who will primarily be utilizing NICB s state of the art technology in the form of the InfoGlide and Memex Systems. Field analysts are located in each of the eight field offices. They collect human intelligence and network information. Identify possible strategic investigations. Organize intelligence data into standard formats for analysts and work closely with Special Agents and other field staff. The HQ Strategic Intelligence Group: Collects data from electronic sources before insurance carriers even know it. Receives organized intelligence data from field analysts. Performs desktop investigations using the SSE (Similarity Search Engine) and other software. Represents NICB s proactive effort. The Tactical Intelligence Group: Collects data from Field Agents and Strategic Intel Group. Responsible for analyzing & organizing data into visual media. Performs desktop investigations using the SSE and other software. Represents NICB s (reactive) effort to build large-scale cases for prosecution and investigation.
7 Statistical Research Analysts: Use advanced statistical models to identify trends Statistically forecast activity Evaluate productivity and the allocation of resources Profile perpetrators and their targets THE INTELLIGENCE PROBLEM Intelligence data is collected in a wide variety of formats from a multitude of sources, making the organization and analysis difficult. Human intelligence, member data, public databases, law enforcement and confiscated records comprise some of the databases that could be accessed to obtain raw data. Data is useless by itself, so it needs a standard method to organize it in order to generate intelligence information. THE NICB INTELLIGENCE NETWORK The NICB Intelligence Network is the key to processing intelligence data. The network collects, organizes and analyzes intelligence data in a systematic fashion. This group acts as a centralized intelligence force that can freely exchange information with other intelligence personnel, field staff and administrative management. Forewarn is a product providing a series of tools enabling NICB customers to make more informed claims decisions and providing advance knowledge on where fraud might occur. Forewarn is a process and system that gathers, records, analyzes and organizes insurance crime information and intelligence for NICB customers. Forewarn is a NICB network, which gathers information and data and provides analysis. The Forewarn network consists of the Special Agents, the SIU s, the Field Analysts, the databases (ISO, NICB and public) and the strategic and tactical analysts. The distribution of the analyzed information to the customers and law enforcement is the intelligence product that Forewarn delivers. Forewarn analysis is available via a variety of delivery mechanisms including the Internet, Special Agents and bulletins. Forewarn products include strategic and tactical intelligence as well as crime analysis. THE INTERDICTION PROGRAM Vehicle thieves target our border and coastal communities and more than 200,000 vehicles are illegally exported each year. The Interdiction Program focuses on the top 50 land and sea ports. We have data entry and investigative personnel assigned to each port to stop the flow of stolen vehicles out of the country. The purpose of the Interdiction Program is to ID stolen vehicle trafficking patterns. These patterns then become intelligence for our Predictive Knowledge capability. Utilizing technology to analyze these patterns provides valuable information to our members and law enforcement. It allows us to target and stop vehicle theft rings in the areas that are most affecting our member companies. In addition, the Interdiction Program benefits are: Electronic reporting of export records. Stolen vehicle recovery.
8 Efficient use of limited resources. Focusing on domestic and foreign influence. Stopping claims prior to loss payment. Possible prosecution of vehicle thieves. TRAINING PROGRAMS NICB offers many training options to our customers and law enforcement. We have implemented a new program featuring over 58 Extended Trainers who are Special Agents. These agents received intense specialized training enabling them to speak on a variety of topics related to insurance fraud and bring a wealth of knowledge to the training process. They can be contacted directly or through their Training Director. In addition to our new ET program, we continue to offer many options for training including our Fraud Video series and Fraud awareness documents. We offer customized training as well by meeting with our customers and assisting them with specialized programs. NICB has two specialized academies that are offered approximately 4 times a year. The Mega Academy is designed for the new SIU Investigator or claims examiner, but also appeals to L.E. and other governmental agencies involved with insurance fraud investigations such as DOIs and fraud bureaus. The Specialized SI Academy exists to train journeymen insurance investigators in advanced investigative skills. The academy provides training in complex, multiple claim investigations and in specific advanced investigative techniques and knowledge. The popular FraudSmart programs are 45 minute - to 1 hour modules offering a variety of opportunities to cut and paste different training modules together to create a more customized program for our customers. Almost all of the training initiatives are conducted to assist the claims representative in detecting questionable single claims and reduce fraudulent claim payments. OUTREACH PROGRAMS The National Office located in the Washington DC office, establishes the NICB as a national presence both legislatively and with the media. This office creates national visibility and maintains a small staff. NICB maintains an active website, The website has two levels: Consumer access consists of public items of information about NICB and VinCheck. Member Secure access provides member companies specific information from STI and GPA, as well as other departmental information. As groundbreaking events in insurance fraud detection and investigation occur, information will be able to be accessed on our website, as it becomes available. The website will be updated periodically to reflect new information in a timely manner.