| |
| Volume
4, Issue 7 |
BUSTED:
Victories for Truth, Justice, and Lower Insurance Premiums |
Eat,
Drink and Be Merry
by
a DMA Investigator, Los Angeles
Those inclined to commit
insurance fraud can be skilled and persuasive
actors. Many take great care to stay in
character as their claim proceeds. But there
is something about the holidays that distracts
even the most dedicated of conmen and con-women.
Maybe it is something in the eggnog. Perhaps
the spirit of the season just overcomes
the caution that dominates a fraudster’s
life in other months.
This case came to us from defense counsel
and had a high exposure (close to $400,000).
Our subject was supposedly completely
disabled in her right hand. Our first
attempt at surveillance, in the fall of
the year, found her playing her part,
using her left hand. But the file had
enough red flags that we scheduled additional
surveillance in December.
We
picked her up on the way to the mall.
Maybe it was the sale at the Gap that
caused the forgetfulness. At once we had
her on film using her right hand to carry
her purse, open the doors at the mall
and, after having successfully made several
purchases, holding and dialing a cell
phone.
This was a great start, but we needed
more to eliminate the “one of my good
days” attack on hard film evidence.
Some
days later we picked her up late in the
day and followed her to a restaurant.
We filmed her use of her right hand opening
and closing a car door, opening the door
to the restaurant. As I got set to wait
for her to come out, I noticed that this
restaurant had seating near an expanse
of large windows providing a lovely view
for those outside as darkness fell and
the lighting inside came up. I thought
it would be too much to ask for that she
should choose a window seat, but I had
to check it out. Sure enough, there she
was with her companion in full view and
amazingly enough there was a parking space
across the street. 59 minutes later I
had the entire meal on film, all of it
eaten right-handed (including some fancy
twirling of the pasta onto her fork and
some vigorous cutting of some unknown
substance).
It is a wish common to
the holidays that one and all get what
they deserve. This applies not only to
iPhones, designer bags and video games
for the good boys and girls. It also applies
to those with $400,000 bogus claims -
potentially ill-gotten gains that will
drive our premiums and blood pressure
higher if paid. When such a claimant has
to settle for less than 5% of demand,
hardly enough after attorney fees to cover
the credit card bills run up while starring
in our surveillance videos, holiday justice
has been served. The lump of coal in her
stocking is beyond our powers, but we
are contemplating asking permission to
send a copy of our video to Santa so that
the case might be wrapped up in full.
|
THE
LEGAL ARENA |
FLASH
REPORT
Bureau Recommends 5.2 Percent Hike At Rate
Hearing
The Workers' Compensation Insurance Rating Bureau
of California yesterday made its case to
the Department of Insurance for a 5.2 percent
pure premium rate increase. The Bureau's
revised filing is one percentage point more
than its original submission in September,
an increase necessitated by Governor Schwarzenegger's
endorsement of AB 338. If Insurance Commission
Steve Poizner approves the filing for advisory
rates on Jan. 1, 2008, it'll be the first
increase since July 2003 and perhaps a portent
of things to come. Poizner was unable to
attend the rate hearing due to the Insurance
Department's in working with policyholders
and insurers dealing with the raging Southern
California fires. That left Chris Citko,
CDI senior staff counsel, running the meeting.
The Bureau's original filing
proposed a 4.2 percent increase contingent
upon the governor not signing AB 338. The
new law, which affects workers injured on
or after Jan. 1, 2008, increases the window
during which injured workers may use their
temporary disability benefits from two years
from the date of the first benefit payment
to five years from date of injury. Schwarzenegger
signed the bill into law earlier this month.
According to Dave Bellusci, chief actuary
for the Bureau, this change will eliminate
about one third of the TD savings realized
from SB 899.
Despite the signing of AB
338, the greatest factor in the Bureau's
proposed increase was the affects of loss
adjustment expenses – that is the costs
associated with adjusting claims. Loss adjustment
expenses have not decreased commensurate
with the decline in losses from accident
years 2003 through 2006. This factor accounts
for 3.5 percentage points of the proposed
increase. As for reasons that the LAE are
not declining, Bellusci points to new medical
utilization review procedures, legal challenges
to regulations and legislation, and challenges
to the Permanent Disability Rating Schedule
that are likely increasing the cost of administering
claims.
"To the extent that
there will be reduced litigation, we haven't
seen it yet. Maybe when the smoke clears
from the reforms, we'll see a decline in
loss adjustment expenses," Bellusci
said at yesterday's hearing.
Bellusci also informed the
Department that the data submitted by AIG
and Virginia Surety Insurance Company are
included in the rate filing. AIG and Virginia
Surety's data were excluded from the July
rate filing because of data inaccuracies
and anomalies respectively, but they have
since remedied the deficiencies. However,
the data of Arch Insurance Company were
excluded because of data anomalies. Arch
has less than one percent of the market
share in California.
Next
year's rate is now in the hands of Poizner,
who must either accept the filing or reject
and order a different rate change in either
direction. Insurers, however, are not required
to use the pure premium rate and may price
policies as they see fit.
Source: Worker's Comp Executive
Copyright © 2007 Providence Publications,
LLC - All Rights Reserved.
|
WORKERS' COMP NEWS |
California
State Fund Holds Line On 2008 Rates
by
Walter Olson, overlawyered.com
 California's
State Compensation Insurance Fund has announced
the filing of its Jan. 1, 2008, rating plan,
making no change in the average collectible
rate level. SCIF held the line on rates
despite the Workers' Compensation Insurance
Rating Bureau's filed recommendation for
a 5.2 percent average rate increase effective
January 1.
State Fund's rating plan adopted the Workers
Compensation Insurance Bureau's recommended
changes in individual class loss costs.
Individual employers will therefore see
differences in their pricing due to changes
in their classification loss costs, experience
modifications, and other changes in rating
plan features. Overall, however State Fund's
average collectible rate level will be unchanged.
Small employers (premiums between $1,000
and $59,999) with superior safety records
will continue to receive a 10 percent workplace
safety credit. "Small businesses are
crucial to the California economy. State
Fund is pleased to be able to reward these
employers for maintaining safe workplaces,"
said State Fund President Janet Frank.
"Employers are enjoying the benefit
of a healthy, competitive workers' compensation
market that is directly attributable to
passage of the Governor's reform legislation
in 2004, SB 899, and earlier 2003 reform
legislation, AB 227 and SB 228," she
continued. "State Fund's rate filing
reflects our role as a carrier of choice
for many employers, as well as the safety
net for any employer needing workers' compensation
insurance in California."
State Fund's rate level remains 55 percent
below pre-reform 2003 rate levels. The new
rates will apply to new and renewal workers'
compensation policies with an effective
date on or after Jan. 1, 2008.
For more information, visit www.scif.com.
Source:
SCIF
Printer
friendly version
|
CALL
DMA
Investigations WORKERS
COMP INVESTIGATORS
WITH
YOUR NEXT INVESTIGATION
19 OFFICES IN CALIFORNIA, 45 OFFICES IN 16 STATES
(800)
649-7602
|
DON'T
FORGET TO SUBSCRIBE TO "BUSTED"
WHICH COMES OUT MONTHLY BY EMAIL
CLICK HERE
|
|
|
