Insurance
is protection .. .. Insurers indemnify loss or damage arising out of an insured
peril – financial protection for a loss arising out of a fortuity – sudden and
accidental loss, during the policy period.
Every industry needs it – upon consideration, i.e., payment of a small
premium, the Insurer offers to protect the subject matter and effect payment
when loss or damage occurs. Insurance industry is centuries old and there is
something that ails it almost since its origin ~ the insurance frauds. Policy holders seeking unholy and fraudulent
means to derive benefit under the policy which includes exaggerating values,
manipulating losses, inventing cause of losses and more – all arising out of
greed, dishonesty and infidelity of people !
Financial frauds
are associated with sophisticated urban areas but are not necessarily
restricted to urban areas – it is prevalent in rural areas too. When cyclone struck, there were many claims
for damage to building and to trading stock – in many cases, they had inflated
the values and taken loans – and some resorted to putting up exaggerated claims
with bank statement as proof ! some frauds are occasioned by combination of
poor due diligence in writing policies by insurance companies and the
organisational efficiencies of criminals in identifying loopholes and
manufacturing documents fraudulently, as the World revolves more on documentary
establishment.
Do
you know that Insurers against whom such frauds are made, can pursue criminal
action ? ~ further all policy contracts
do contain a clause which can be invoked by the Insurers. For example, the Standard Fire & special
Perils Policy – condition 8 states : If the claim be in any respect fraudulent,
or if any false declaration be made or used in support thereof or if any
fraudulent means ordevices are used by the Insured or any one acting on his
behalf to obtain any benefit under the Policy or if the loss or damage
be occasioned by the wilful act, or with the connivance of the Insured,all
benefit under this Policy shall be forfeited.
Miles away, the embattled
superintendent of Indiana's Elwood Community Schools resigned her position. In a Friday
school board meeting came the announcement that Casey Smitherman had stepped down. Smitherman
had been arrested recently and charged
with insurance and identity fraud after she took a 15-year-old male student to
a private clinic for treatment of possible strep throat. At the clinic, she
allegedly claimed in insurance paperwork the student was her son.Nothing novel or new, as in a PSU, an employee preferred
mediclaim reimbursement when a neighbor woman had been admitted in an hospital
for a surgery and she had the same name of his mother-in-law. In another instance, a woman came and screamed
in the Office, as the man had taken some other woman on tour and claimed leave
travel subsidy .. ! for family travel.
In an
old movie, Goundamani and Senthil would plan – Senthil to fake his death – and
the due would claim fat money of 2 lakh ! from the life insurer. Years later, in 2005, in what is known
as John Darwin case, it was faking one’s own death – the first trouble is in the lack of a body. That was tackled in
a creative way by Texans Clayton and Molly Daniels in 2005 who proceeded to dig
up a corpse from a local cemetery and place it in their burning car. Clayton
would then disappear, Molly would collect $110,000 and he would somehow
re-appear as her new boyfriend. In truth, their endeavours were very elaborate
as she researched into how to burn a body effectively and sought tips on
defrauding insurers. There was one gaping flaw in their plan however - the body
was that of an 81 year old woman and DNA testing was onlyaction really necessary to confirm what the police
already knew.
MailOnline now
reports that a New Jersey man is facing accusations of insurance fraud after he
was caught on video throwing ice onto the floor and faking a slip and fall. The report states that Alexander Goldinsky,
57, of Randolph, New Jersey, faked a
slip but could be seen in a surveillance video from a cafeteria at a
Woodbridge, New Jersey.
Goldinsky, an
independent contractor operating under a company named All Gold Industries, was
allegedly subcontracted to do work for the Woodbridge business when the fraud
took place.In the video posted on the prosecutor's Facebook page, the
57-year-old can be seen filling a cup with ice from a soda machine in the
cafeteria, then walking away a short distance before deliberately spilling the
ice onto the floor.He then turns around, takes small steps walking back to
where cubes are visible and quickly looks around before gingerly lying down on
the floor. Goldinsky then waited on the floor until he was discovered,
according to the prosecutor's office.
'Fraudulent claims
cost everyone and we will aggressively prosecute those who illegally manipulate
the system,' said Carey.He was arrested on January 15 for filing a false
insurance claim for the ambulance ride and local hospital treatment for
injuries he claimed he sustained in the 'fall.' Goldinsky faces one count of
insurance fraud in the third degree and one count of theft by deception in the
third degree for the insurance claim. He was released on a summons and he's
scheduled to appear in court on February 7. The
prosecution of Goldinsky is part of the New Jersey Attorney General’s statewide
crackdown on insurance fraud crackdown through the County Prosecutor Insurance
Fraud Reimbursement Program.
With
regards – S. Sampathkumar
No comments:
Post a Comment