The Obligation of an Insurance Professional to Defeat Insurance Fraud
It is the obligation of all who work to protect insurers against insurance fraud to do something to change the situation. Methods that are available and that should be exercised by every person who wants to reduce the effect of insurance fraud include:
- Lobby to change the system so that:
- all the money goes to all kinds of insurance fraud at the discretion of the Commissioner of Insurance;
- prosecutors must be assigned to the Fraud Bureau and their only job must be to prosecute insurance fraud; and
- when the local District Attorney does not file a criminal complaint, the fraud investigator or lawyer for the insurer, must complain, loudly.
- report every suspected fraudulent claim to the Fraud Division;
- follow-up with the Fraud Division after you get the letter saying they won’t investigate;
- supplement the Suspected Fraudulent Claim (SFC) report with investigation results and transcripts of examinations under oath;
- develop a personal relationship with investigators at the Fraud Division; and
- develop a personal relationship with supervising investigators at the Fraud Division.
- When the Fraud Division refers a case to a prosecutor determine the identity of the prosecutor.
- make it clear to the prosecutor that you represent an interested and proactive victim;
- make it clear to the prosecutor that your insurance company is upset that it is the victim of a crime;
- make it clear to the prosecutor that you will make available to him or her anything required;
- make it clear to the prosecutor that you, and other employees of the insurance company, will be available to testify;
- if you are in California and sixty days go by after the case is referred to the District Attorney demand compliance with the requirements of the California Insurance Code. California Insurance Code § 1872.4 provides, in relevant part, as follows:
If prosecution by the district attorney concerned is not begun within 60 days of the receipt of the commissioner’s report, the district attorney shall inform the commissioner and the insurer as to the reasons for the lack of prosecution regarding the reported violations.” [Italics added]
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as a
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts