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Rita was five months pregnant. Her entire family greeted her condition as an opportunity to earn enough money for a Merry Christmas in sunny Hawaii.
For four generations, Rita’s family has lived luxuriously on insurance claims. Their last names changed more often than their underwear. Wherever they go, they carry a small plastic valve with soap and a small razor. Depending on the size of the city they visit, they stay for a week, a month or a year. A family member will claim to have slipped and fallen in a restaurant or grocery store. With the razor, they will cause bleeding at the hairline or on an arm or a leg. They will be nice victims with no interest in profit. Grocery stores and their insurance companies decide quickly and fairly their claims for fear that their damages will increase.
Rita had been a job seeker since she was eight. She fell for the most luxurious restaurants in Las Vegas, New York City, Baltimore, Washington, DC, St. Louis, Missouri and Beverly Hills, California. Shortly after she started walking, her family taught her how to slip and look like she was injured without actually causing any physical injury. When she was five years old, she could limp on both legs, keep one arm limp, jerk at pain when touched and give all the symptoms of a seriously injured person.
When she was ten, she had a clear knowledge of anatomy and knew all the symptoms of soft tissue injury. Now, at 22, pregnant with the baby of a sailor she met in San Diego whose name she does not remember, Rita is ready to go into big, lucrative scams. Her brother Aaron would pose as her husband while working at the major hotels and restaurants in Sacramento, California. At the Holiday Inn, she fell into a pool of water in the lobby toilet where two innocent women ran to her aid.
“Oh my God!” Draw moaned. “I hurt the baby.”
Rita rode to the hospital with her “husband” sitting in the ambulance next to her and twisted her hands. They left their name, an e-mail address and a telephone number that connected the family’s mobile phone to the hotel. She and the child were found healthy and had to leave, although the doctor, due to a family history of the miscarriage, noted in the hospital record that the condition here was “monitored” and that she should carefully watch out for any spots or other signs of a potential miscarriage.
Over the next four days, Rita dropped by five hotels, two department stores and three restaurants in greater Sacramento. She went to the hospital in an ambulance twice and visited a local chiropractor that her family knew four times.
The family lived and traveled in three sixty-foot campers equipped with cell phones, a computer and all the comforts of a luxury home. The family knew better than to be greedy. They never presented more than 10 claims each in a city.
Rita and Aaron were reasonable people. They told the adjusters that they did not want to hire a lawyer. Although they were afraid that they would lose the child, the doctors had assured them that the child was unharmed.
The adjusters, who felt an ability to resolve the claim quickly before the baby was born, with any additional damage, worked quickly to win Rita and Aaron’s trust. They wanted a release that would protect their clients.
They had no knowledge of Rita’s family history. The responsibility was clear. Independent witnesses observed a slippery, soapy substance on the floor and on Rita after she fell.
Rita and Aaron were professional presenters. They gambled on the innocence and good faith of the insurance adjusters. They would tell the adjusters:
“We do not want money. We simply can not afford to pay the doctors’ bills. Please pay them for us and we will be happy.”
The adjusters, who knew the law and knew that Rita would be entitled to money for her pain and suffering if a lawsuit was initiated, and insisted that Rita would take more money than the medical bills. Most of the claims were settled for between $ 6,000 and $ 25,000, depending on the generosity or gullibility of the individual adjusters.
Rita’s potential miscarriage gave her family over $ 100,000 for their stay in Sacramento. Her brothers, sisters, cousins and nephews who fell all over the city generated an additional $ 100,000 in damages.
Their welcome in Sacramento worn thin, the family campers traveled west to San Francisco.
The campers were parked in a secure long-term parking lot and the whole family boarded a plane for a three-week vacation in Maui.
The reason why a group of professional claimants can succeed is because the insurance companies have not succeeded in conducting a complete and thorough investigation of a submitted claim. Had the adjuster examined Rita’s claims and had they checked the database for all claims, the crime would have failed.
(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 handling, insurance bad faith 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 email@example.com.
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