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True Crime of Insurance Fraud Video Number 44



See the full video at https://rumble.com/vytsi0-true-crime-of-insurance-fraud-video-number-44.html?mref=6zof&mrefc=3 and at https://youtu.be/r7wqYfXHgE4

Barry Zalma, Esq., CFE presents videos so you can learn how to commit insurance fraud and what is necessary to discourage or defeat insurance fraud. This video blog about true crime fraud insurance stories with names and locations changed to protect the culprits are all based on surveys done by me and fictitious to create a learning environment for claimants, SIU investigators, insurance companies, police and insurance fraud lawyers can be used to deter or defeat a fraudulent insurance claim.

Insurance premium fraud

Insurance fraud is not limited to false claims. Most people do not make statements. The basic principle on which the insurance is based requires that many people pay small amounts so that few can collect. If the risk is not distributed fairly among the many, everyone is affected.

Most business people would be shocked by a suggestion that they inflate a statement. They are honest in their business. They keep their contracts and pay their bills. They rarely have insurance claims. When they have a claim, they act fairly and honorably with their insurer.

Paying insurance premiums hurts. The market is competitive. Prices vary from insurance company to insurance company. The competence varies from insurance broker to insurance broker.

Eventually, businessmen learn how insurance companies set their premiums. They know that prices are applied to modifiers such as the size of the structure, the payroll or the company’s gross revenue.

A businessman sitting with his insurance broker asks how he can get the lowest premium. He will often put his morale on ice when the broker suggests that he appreciate a lower gross profit. The businessman will not see anything wrong with losing 10,000 square feet of his 50,000 square foot warehouse when applying for insurance. When asked to list the payroll for his employees’ compensation policies, he will be unconcerned when he tells his broker that the payroll is $ 200,000 less than it actually is. It’s just good business sense to lower your employees’ compensation premiums. When his policy shows that factory workers cost more to insure than clerks, he “accidentally” reports to his occupational safety insurance that ten percent of his employees are factory workers and ninety percent are clerks, even if the opposite is true.

What the businessman does not know, and what his broker does not tell him, is that deliberately misrepresentation of an essential fact [and there is nothing more material to an insurer than the basis upon which the premiums are calculated] is fraud. Insurance fraud in the acquisition of insurance has both civil and criminal penalties.

An insurance broker who helps and insures lower premiums based on false information is equally guilty of fraud. The agent or broker who does not require the insured to sign an application will, if the fraud is discovered, discover that the insured will refuse to be informed of the application. He will just say, “I trusted my broker. My records were obvious in my office. All he had to do was ask and I would have told him the truth.”

The broker, in the face of such a situation, will find himself defending lawsuits raised by the insured and the insurer.

The California Insurance Code now requires the following warning on all claims documents presented by insurers to the insured:

FOR YOUR PROTECTION, THE LAW OF CALIFORNIA REQUIRES THE FOLLOWING OF THIS FORM

EVERY PERSON WHO CONSCIOUSLY PERFORMS FALSE OR FRAUDIBLE RESPONSIBILITIES FOR PAYMENT OF A LOSS IS CRIMINAL TO CRIME AND MAY BE FINE AND IMPRESSION IN STATE PRISON.

I believe, in order to protect the insured, the broker and the insurer, that the law should be amended to require the same warning in every application for insurance. A warning will not stop a person who intends to commit fraud. However, it will remind the honest businessman who is tempted to commit fraud to get a lower premium on the risks of his actions.

Insurance fraud is not limited to false claims. Most people do not make statements. The basic principle on which the insurance is based requires that many people pay small amounts so that few can collect. If the risk is not distributed fairly among the many, everyone is affected.

What the businessman does not know, and what his broker does not tell him, is that deliberately misrepresentation of an essential fact [and there is nothing more material to an insurer than the basis upon which the premiums are calculated] is fraud. Insurance fraud in the acquisition of insurance has both civil and criminal penalties.

Every claims adjuster and investigator should review every word in the application and obtain the insured’s response, which is presented as if the adjuster has no knowledge of the answers to the application form or is criticized for not having carried out a thorough investigation.


(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his internship to the position of insurance consultant specializing in insurance coverage, insurance claims management, non-insurance and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as a lawyer for insurance coverage and claims management and more than 54 years in the insurance industry. He is available at http://www.zalma.com and zalma@zalma.com.

For the past 54 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created a library of books and other materials to enable insurers and their claims staff to become professionals in insurance claims.

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Write to Mr Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/




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