Thursday, February 2, 2017

Criminal insurance fraud unit investigated 150 cases in 2015, 2016

Many people don’t know that the Office of the Insurance Commissioner investigates criminal insurance fraud, much of which is referred to us by insurance companies themselves. The work is done by the OIC’s Criminal Investigations Unit (CIU), staffed by law enforcement and criminal analysts. They refer the results of their investigations to state and local prosecutors, who bring charges against the people who are suspected of committing the fraud.


CIU staff conduct a search during
an insurance fraud investigation
In 2015 and 2016, the CIU:
  • Received 3,571 referrals, which are questionable insurance cases that consumers and the insurance industry send to us to review.
  • Opened 150 criminal fraud cases.
  • Submitted 52 cases to a prosecutor.
  • Had 40 criminal cases charged; 37 of those were heard before a judge.
  • Had 44 convictions for various crimes.
  • Saved $3.6 million in immediate and projected insurance claim payouts. These efforts resulted in $857,353 of restitution ordered paid back to victims and $26,760 in court costs ordered back to the judicial system.
  • The vast majority – 73 percent – of the cases we investigate involve personal property or property damage. Bodily injury frauds are 11 percent, fraud by insurance agents and brokers (called producers) is 6 percent, and the rest involve disability, a medical provider, staged auto collisions or other types of cases. 
Other information about CIU:
  • CIU was established by the Washington state Legislature in 2006. Since then, we have pursued 434 cases and adjudicated 105 of them. Our workload has steadily increased each year.
  • It maintains a list of insurance fraud most wanted suspects, who have been charged with a crime but did not appear in court to face the charges. 
  • In November 2016, the CIU earned law enforcement accreditation from the Washington Association of Sheriffs and Police Chiefs (WASPC), joining the 20 percent of law enforcement agencies in the state to have it.
  • CIU hosted the 19th annual 2016 Fraud Directors Conference, a gathering of more than 70 insurance fraud professionals from 26 states and DC. It was the first time the conference has been held in Washington state. 
  • The insurance commissioner is required by law to appoint a 10-member volunteer board to advise him on fraud investigations.
Read more in the CIU’s most recent report to the Legislature.