Zalma’s Insurance Fraud Letter – November 1, 2019

Fake Certificate Provided to Gain Right to Work Defrauded General

Fake Certificate Provided to Gain Right to Work Defrauded General
Forging a Certificate of Insurance is a Crime
 

Every construction contract requires that subcontractors provide certificates of insurance as a condition of working on the construction project. Many subcontractors do not have liability insurance that would fulfill the requirements of a general contractor and owner of a major construction project. To get the work some are tempted to provide fake evidence of insurance.

In Terrence Roberts v. The State of Texas, NO. 03-18-00224-CR, Texas Court of Appeals, Third District, at Austin (October 11, 2019) a jury convicted Terrence Roberts of the class A misdemeanor offense of forgery. The trial court sentenced him to 365 days’ confinement and a $3,000 fine but suspended imposition of sentence and placed him on community supervision for twelve months. Roberts appealed.
CLM Launches Universal Claims Certification
I am a fellow of CLM and pass on to my readers this annoucement from the organization important to anyone involved in claims handling.
The CLM, a member of The Institutes, has launched the Universal Claims Certification (UCC), allowing claims adjusters to more easily secure licenses in multiple states. Both currently licensed and unlicensed adjusters can acquire a UCC.
Currently licensed adjusters must simply register for the UCC, whereas unlicensed professionals must first complete a 40-hour course and exam to earn it. Once professionals acquire the UCC, they can quickly obtain a license in all states in which the UCC is approved.
 
“Insurance Fraud – Volume I & II”
How Lawyers & Claims People Defeat Insurance Fraud
“Insurance Fraud – Volume I and II” are updated, revised and easier to read and use change to “Insurance Fraud & Weapons to Defeat Fraud.”
Insurance fraud continually takes more money each year than it did the last from the insurance buying public. No one knows the actual amount with any certainty because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year.
Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored.
No one will ever be able to place an exact number on the amount lost to insurance fraud. Everyone who has looked at the issue knows – whether based on their heart, their gut or empirical fact determined from convictions for the crime of insurance fraud – that the number is enormous.
When insurers and governments put on a serious effort to reduce the amount of insurance fraud the number of claims presented to insurers and the pseudo-government-based or funded insurers drops logarithmically. Since the appointment of Attorney General Sessions, the effort to stop insurance fraud against Medicare and Medicaid has increased.
This book contains appellate decisions regarding insurance fraud from federal and state appellate courts across the country and full text of many insurance fraud statutes.
It is available as both a legal research tool and a product to assist insurers, insurance company personnel, independent insurance adjusters, special investigation unit investigators, state fraud investigators and insurance lawyers to become effective persons involved in the attempt to defeat or reduce the effect of insurance fraud.
The New Volumes 1are available as a Kindle book and a paperback at https://amazon.com.
Measuring Fraud
Attempting to measure the extent of fraud it is necessary to develop concise definitions of fraud for the purposes of uniform measurement, and promote the understanding and use of the definitions with industry, government, academia and the media. To do so the agency performing the measurement should:
 *        Make clear the role of exaggerated or buildup claims as they relate to the definitions of fraud since they involve claims that are partially legitimate and partially fraudulent.

*    Investigate the feasibility of developing methods of conducting closed claims studies in non-auto lines, including homeowners, workers’ compensation, life, disability and health insurance.
*    Investigate securing the aggregate reporting data insurers file annually with state insurance departments, to determine whether data could be extrapolated for the purpose of measuring insurance fraud.
*    Develop methodologies for measuring the extent of fraud in the application process, especially in automobile and life insurance.
*    Major anti-fraud organizations should seek agreement on more-consistent estimates.
*    Major anti-fraud organizations should resist publishing estimates that are not based on some level of scientifically valid empirical studies.

The Current Issue Contains the Following:

Books

The Zalma on Insurance blog has posted over 2850 digests of insurance appellate decisions and other important insurance materials and articles published five days or more a week and are available at http://zalma.com/blog.

I have completed a video blog called

Zalma’s Insurance 101 

Zalma’s Insurance 101  consists of 1022 three to four minute videos starting with “What is Insurance” and moving forward to insurance fraud investigations explaining the basics of insurance and insurance claims handling in a painless fashion that can be viewed every morning with the first cup of coffee at  Zalma’s Insurance 101.
If you start at Volume 1 at the bottom of the blog’s first page and view one or two videos a day you will have approximately 12 to 24 hours of training a year until you get to the last video.
The videoblog is adapted from my book, Insurance Claims: A Comprehensive Guide available at the Zalma Insurance Claims Library

About Barry Zalma

An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
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