Enlisting policyholders could tip the scale in enacting anti-fraud bills

If you use eBay, chances are you received an email this week encouraging you to sign on to its campaign to limit taxes on and regulation of selling stuff online. Its message is simple: More taxes = more costs for both buyer and seller.

A link in the email takes you to a sample message  you can send to legislators. You just need fill out a brief form with your personal info, and click “submit.”

We have no doubt that such grassroots tactics work. A similar program created by the Coalition a few years ago found that generating as few as a handful of emails to a legislator can make a difference. Legislators do notice email from constituents. Legislators often vote for constituent wishes, and even co-sponsor bills based on support from voters.

That said, why don’t more insurers enlist the support of their policyholders in their own legislative battles when those initiatives serve the public interest?

For example, homeowners in South Florida face steep increases in homeowners premiums thanks to the state’s allowing assigning of insurance benefits and payment of outrageous attorney fees. The outrage expressed by consumers should be turned into a campaign to pressure legislators for relief from related scams.

Drivers in New York face some of the highest auto rates in the U.S., due in part to the state’s loose no-fault laws. Surely auto policyholders would sign on to a legislative campaign if they thought the outcome could put downward pressure on rates. The list goes on and on.

When questioned, insurers don’t always have good answers. Many are reluctant to enlist policyholders out of fear of offending them. Such campaigns also could backfire by inspiring adversaries (lawyers, doctors, roofers, etc.) to aggressively counter other legislative initiatives important to insurers.

I get all that. But it still seems that selectively enlisting policyholders could tip the scale on anti-fraud bills, and help insurers convey that they’re looking out for their policyholders’ best interests.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Families torn apart by relentless pursuit of bogus whiplash claims

Corruption by stealing insurance money can creep up on normally decent people. The opioid-like lure of easy money grinds away at even your deepest-held values, shifting a well-lived life into a corrosive money grab that breaks apart a helpless family when fraud prosecutors come knocking.

Jason Dalley was a personal-injury lawyer. He also was a loyal Little League Coach, respected in the community and a devoted family man.

Andrew Rubinstein was a Ukrainian emigre, and the glue that held his family together amid the weight of personal tragedies. Dalley’s and Rubinstein’s decisions to steal insurance money for a fraud ring in South Florida sliced through families that depended on them.

The duo signed up with a staged-crash ring that siphoned $23 million in bogus whiplash claims from 10 auto insurers in South Florida. All the while, helping drive up auto premiums for honest Florida drivers.

A cartel of medical clinic owners, chiropractors, attorneys and others teamed to fleece auto insurers with inflated and fake whiplash injury claims. Recruiters steered the crash victims to them. Dalley and Rubinstein were key cogs.

Greed caught up attorney

At first, Dalley was a bit player with the ring. He paid kickbacks of $2,000-$2,500 to tow-truck drivers and street recruiters to illegally bring him the crash victims. Medical providers inflated claims for chiropractic treatments, often forging medical records for treatments that never happened.

“The remorse you felt was only after you were caught. The illegal activities … affect every consumer by increasing their annual insurance premium cost,” the judge said.

Dalley filed bogus insurance claims for the crash victims, whether they were injured or not. He helped force large claim settlements with the defrauded auto insurers. The entire ring was hyper-efficient, seemingly invincible. Millions of insurance dollars tumbled down. Everyone got a cut of the money, lining their bank accounts handsomely.

Fraud investigators and prosecutors eventually cracked open the ring, hauling Dalley, Rubinstein and other cohorts into court.

Dalley had lived a clean, respectable life until greed overcame his values. He was involved in community causes, including coaching a Little League team for 15 years in Boca Raton. Be good people and play the game well, he urged the young ballplayers as their ball coach and life mentor.

His wife and three teen sons were devastated when Dalley was convicted. He was in tears when he admitted to the court that he started slowly with scamming until becoming drunk with easy money. He was the family’s rock, dumped into federal prison for a year and nine months. Dalley’s law career also is over. He’s losing his license, leaving his family to somehow make do on its own. Dalley also must come up with $1.8 million in repayment.

Made clinics into puppet operations

Rubinstein took over ailing clinics, installing straw owners to hide his illegal ownership of the puppet operations. The clinics were little more than factory lines churning out bogus whiplash claims.

He spent his wads of insurance money on day-to-day expenses, his family’s home, vehicles and vacations. Rubinstein’s 16-year-old daughter, Michelle, cried as she made a heartbreaking plea to try and keep her father out of prison. Rubinstein held their family together as her mom struggled with mental health problems and alcoholism before suffering a fatal stroke, Michelle told the judge.

Rubinstein had every chance to make a clean living. He’s an Ivy League-educated occupational therapist and former engineer. Instead he kept scamming auto insurers for two years even after learning he was being investigated. Judge Beth Bloom knew sentencing would be hard for Michelle and Rubinstein’s step-son, their family now broken up. Bloom still handed him six years in federal prison.

“The remorse you felt was only after you were caught,” the judge said. “The illegal activities … affect every consumer by increasing their annual insurance premium cost.”

Many consumers complicit with “little white lies,” more Americans need to report scams to fraud hotlines

The header is hardly a typo, nor does it refer to the honest organization called the Coalition AGAINST Insurance Fraud. I’ve talked with many people about my work with that alliance. Often with a smile or chuckle, I’m asked, “Well, is there also a coalition in favor of insurance fraud?” These humorous exchanges made me realize that there IS such a group. It’s informal, and millions of people belong. Many of us may be active members, or at least complicit. 

It seems almost everyone knows someone who has committed, or is committing, insurance fraud. Maybe not a crass arsonist or hardened leader of a large staged-crash ring. Though instead, maybe a co-worker, friend or family member who wasn’t injured, yet made a false workers-comp or bodily-injury claim. Or maybe the person (or ourselves?) who adds just a “little bit” to inflate a claim and compensate for the insurance “hassle,” cover a deductible, or get a new TV that’s better than the one that was stolen from the living room. 

People can be surprisingly tolerant of this crime, and hence members of the “Coalition FOR Insurance Fraud.” At least a quarter of U.S. adult consumers believe it’s okay to pad a claim to make up for the deductible. Nearly 20 percent approve of inflating claims to cover premiums paid in the past. Fully 10 percent believe insurance fraud doesn’t hurt anyone. These could be our neighbors, co-workers, friends and family members. 

So why would someone join this crime-committing group? Nearly seven of 10 people believe people steal insurance money because they feel they can get away with it.

So how many “members” belong to this nefarious Coalition? The U.S. has slightly more than 325 million people. This means 65-80 million U.S. adults could be fine with padding claims, and more than 30 million feel insurance fraud has no impact on them or our society. Given the 150 members of the good-guy Coalition … we’re outnumbered by thousands of percentage points!

Normally honest consumers may claim we, and perhaps even close friends or family, aren’t members of the dishonest “coalition.” Yet how often have we heard others, or even ourselves, suggest someone try a false personal-injury claim to line their bank account? Or we know a co-worker who complains of back pain for years, then falsely claims a “new” workplace back injury? 

And how many insurers pay a claim, knowing the entire claim or a large  portion, may be fraudulent? Yet for a variety of reasons — from getting rid of a nuisance claim to budgetary constraints — the insurer simply pays the claim and quickly moves on. 

Those of us who are attorneys are eligible for “club” membership too. In more than 30 years of insurance practice, many of the worst claims I was involved in had insurance professionals and sometimes defense counsel as claimants. I recall phone calls directly asking how to “maximize” the claim payout, and even insurer employees as well as defense lawyers saying this was their “chance” finally to be on the receiving end of a settlement check. This occurred far too often to be isolated incidents or coincidence. 

Far too many of us may be fraudsters indirectly and be complicit by failing to speak out when we see a scam happening.

Will this blog change the equation? No. But blogging raises issues we may not be comfortable talking about. Maybe this blog incited a moral “twinge” if you made an inflated claim that was a “little white lie.” No one is immune from getting caught up in the world of insurance fraud — directly or on the periphery. Hopefully we may learn and grow more honest — regardless of our role or age. Perhaps the next time we see the “dishonest coalition” in action, we’ll speak up or report a scam to our insurance department’s fraud hotline. We can act instead of turning a blind eye or unhearing ear. 

If we’re willing to take that small step, maybe we can remove one more member from that other “coalition,” and strengthen our own Coalition AGAINST Insurance Fraud. 

About the author: Matthew J. Smith serves as general counsel and director of government affairs for the Coalition Against Insurance Fraud.