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Old 07-12-2011, 05:09 PM   #1
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Fraudulent Insurance Issues


Fraudulant Insurance Issues;


Be an Educated Consumer!

Please take a few minutes and Read this document!
Discounted or "free" insurance claim roofing work is AGAINST THE LAW.


Paying for deductibles, even partially, is illegal in many states.

Paying for placing a sign in an insured’s yard is in fact considered a rebate since the insured receive a betterment from their loss. When you submit an invoice to the insurance company to recover the depreciation do you show that you paid the insured? Do you show that you collected the FULL & required dollar figure? If not, & you stated that you collected hundreds or even thousands less than the correct deductible, the insurance company would reduce the recoverable depreciation by the amount you discounted the deductible.

I'm seeing language on claim summaries now that address this issue informing insured’s that it's illegal for them to not pay their fully required deductible.

Example:
Insurance claim for a roof is estimated by insurance @ $ 10,000.00.
Insured (homeowner) has a deductible for $ 1,500.00.
This means the insurance company's portion of "buying the roof" is $ 8,500.00.
However, along comes "Roofer X" who only charges the homeowner / insured $ 500.00 & *not* the full amount.
Roofer X then faxes off an invoice to the insurance co. stating that they collected $ 1,500.00 from the homeowner / insured.
Roofer X is telling the insurance co. they should send out the balance of the claim (the rest of the amount due) & the insurance co. now thinks they have satisfied their part.
If, on the other hand, Roofer X were to send in an invoice with the dollar figure of $ 500.00 paid by homeowner / insured & NOT $ 1,500.00, then the insurance co. would then back off their final check by the amount that Roofer X did NOT collect.
Homeowner / insured is happy, however, because they just paid less than they were supposed to ("hey, it's OK; everyone does it, right?).

WRONG.

Fact: The very moment Roofer X sends off a false invoice showing a higher dollar amount collected from homeowner / insured, then Roofer X has committed fraud.

Fact: If Roofer X provides an invoice (or receipt) to the homeowner / insured & they (not the roofer) then forward this off to insurance, both parties have now committed insurance fraud, however the homeowner has also committed wire fraud AND they are also committing collusion (conspiring to perform an illegal act). ...How nice; Roofer X has just dragged the homeowner down right along with them.

It's really quite simple:
Find a roofing contractor that has good references & one that you think will provide you with the highest level of service / do the best quality job. Pay your full & legally required deductible.
If you have a problem with your deductible, then maybe you need to rethink your premiums. A higher premium will mean a lower deductible, but YOU, the consumer, are the one who makes that choice.

Now, one scam ("on the behalf of the homeowner / insured") is that Roofer X could pay to place a sign in someones yard that they are not re-roofing, that's legal but it's also not very likely.

Since roofing is by its very nature dangerous and potentially deadly these kickbacks can be considered a first degree felony offense. At the minimum it's a state jail felony. If you get caught doing it multiple times they will aggregate the charges.

All it takes is an insurance companies SIU Department to audit an insured. Or the Department of Insurance to investigate.



BUSINESS & COMMERCE CODE
CHAPTER 27. FRAUD

§ 27.02. CERTAIN INSURANCE CLAIMS FOR EXCESSIVE CHARGES.
(a) A person who sells goods or services commits an offense if:
(1) the person advertises or promises to provide the good or service and to pay:
(A) all or part of any applicable insurance deductible; or (B) a rebate in an amount equal to all or part of
any applicable insurance deductible;
(2) the good or service is paid for by the consumer from proceeds of a property or casualty insurance policy; and
(3) the person knowingly charges an amount for the good or service that exceeds the usual and customary charge by the person for the good or service by an amount equal to or greater than all or part of the applicable insurance deductible paid by the person to an insurer on behalf of an insured or remitted to an insured by the person as a rebate.
(b) A person who is insured under a property or casualty insurance policy commits an offense if the person:
(1) submits a claim under the policy based on charges that are in violation of Subsection (a) of this section; or
(2) knowingly allows a claim in violation of Subsection (a) of this section to be submitted, unless the person promptly notifies the insurer of the excessive charges.
(c) An offense under this section is a Class A misdemeanor.

Added by Acts 1989, 71st Leg., ch. 898, § 1, eff. Sept. 1, 1989.

PENAL CODE CHAPTER 35. INSURANCE FRAUD

§ 35.02. INSURANCE FRAUD. (a) A person commits an offense if, with intent to defraud or deceive an insurer, the person, in support of a claim for payment under an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(a-1) A person commits an offense if the person, with intent to defraud or deceive an insurer and in support of an application for an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(b) A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers, pays, or receives a benefit in connection with the furnishing of goods or services for which a claim for payment is submitted under an insurance policy.
(c) An offense under Subsection (a) or (b) is:
(1) a Class C misdemeanor if the value of the claim is less than $50;
(2) a Class B misdemeanor if the value of the claim is $50 or more but less than $500;
(3) a Class A misdemeanor if the value of the claim is $500 or more but less than $1,500;
(4) a state jail felony if the value of the claim is $1,500 or more but less than $20,000;
(5) a felony of the third degree if the value of the claim is $20,000 or more but less than $100,000;
(6) a felony of the second degree if the value of the claim is $100,000 or more but less than $200,000; or
(7) a felony of the first degree if:
(A) the value of the claim is $200,000 or more; or
(B) an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.
(d) An offense under Subsection (a-1) is a state jail felony.
(e) The court shall order a defendant convicted of an offense under this section to pay restitution, including court costs and attorney's fees, to an affected insurer.
(f) If conduct that constitutes an offense under this section also constitutes an offense under any other law, the actor may be prosecuted under this section, the other law, or both.
(g) For purposes of this section, if the actor proves by a preponderance of the evidence that a portion of the claim for payment under an insurance policy resulted from a valid loss,
injury, expense, or service covered by the policy, the value of the claim is equal to the difference between the total claim amount and the amount of the valid portion of the claim.
(h) If it is shown on the trial of an offense under this section that the actor submitted a bill for goods or services in support of a claim for payment under an insurance policy to the
insurer issuing the policy, a rebuttable presumption exists that the actor caused the claim for payment to be prepared or presented.

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995.
Amended by Acts 2003, 78th Leg., ch. 605, § 1, eff. Sept. 1, 2003.

Amended by:
Acts 2005, 79th Leg., Ch. 1162, § 4, eff. September 1, 2005.

§ 35.03. AGGREGATION AND MULTIPLE OFFENSES. (a) When separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense and the value of the claims aggregated in determining the classification of the offense. If claims are aggregated under this subsection, Subsection (b) shall not apply.
(b) When three or more separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense, and the classification of the offense shall be one category higher than the most serious single offense proven from the separate claims, except that if the most serious offense is a felony of the first degree, the offense is a felony of the first degree. This subsection shall not be applied if claims are aggregated under Subsection (a).

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995

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Old 07-12-2011, 05:10 PM   #2
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Fraudulent Insurance Issues


Hail Loss Claims

Suspected cases of insurance fraud, often by roofers and other contractors, after hail damage rose 136% from 2006 to 2009, according to a new report.


Joe Wehrle

The fraud reports increased more than twice the rate of hail insurance claims being filed. Claims for hail losses rose 61%, to 413,000, during the same period, according to the National Insurance Crime Bureau (NICB), a nonprofit insurance crime education and awareness organization.

“These statistics back up what our agents have been experiencing in their field investigations,” said NICB President and CEO Joe Wehrle. “There are a lot of unscrupulous fly-by-night roofers and repairmen who are what we call ‘storm chasers.’ They follow the storms and deliberately try to rip off unsuspecting home owners and their insurers by making unnecessary repairs or deliberately inflicting intentional damage to a roof or siding to try to get insurance money.”

Wehrle said the increase in reports of suspected fraud show word is getting out.

“The increase in questionable hail loss claims shows that insurers are on the lookout for these scam artists, and home owners need to be leery of companies offering a free roof without first checking with their insurer to ensure there is legitimate damage and the repair company is reputable,” he said.

Texas led in both categories. The Lone Star State had 298,798 claims from hail losses and 521 questionable hail loss claims.

Ten states recorded 75% of all hail claims, as well as 82% of the questionable ones, the NICB reported.

The state with highest ratio of questionable hail loss claims to claims was Illinois, with 881 questionable hail loss claims for every 1,000 hail loss claims. In other words, nearly nine of every 1,000 claims filed for hail loss were deemed suspicious enough to forward to NICB for further

Frauds and Scams;



A roofer who hadn’t seen much business lately went neighborhood by neighborhood, offering to do free roof inspections. He offered a story about how the original builder used inadequate roofing materials and that he has personally come across three houses in the neighborhood that would have had serious damage if not for his free inspection. He of course indicates that there is no cost for the inspection, but if damage is found, he can give phenomenal prices due to his crew already being in the neighborhood.

So an elderly woman, who has nothing to lose, agrees to his offer. After all, the man seems nice and sincere, and of course, the inspection was free. Who wouldn’t take advantage of a free offer like this? If such repairs were necessary, it only makes sense that this roofer would be able to give better pricing because of volume within the neighborhood. Allowing him to do this would certainly save her tons of misery if there was damage and the next rain storm caused the roof to leak.

You guessed it; the roofer found that the shingles were weak and poorly attached. A good wind and rainstorm and there would most certainly be major damage. How lucky could she be that this nice man had come along when he did? The $7500 price tag seemed somewhat high, but what did she know about prices? And how ungrateful could she be to question this nice man who’d come along with his free offer and had saved her home. As he kept telling her, he was giving her a 20% discount for signing up right now and ordering the same shingles as the other 3 families.

Again, he had his crew in the neighborhood next week and it only made sense that he could get some quantity discounts if he could purchase triple the usual number of shingles.
Just a few problems:1.The elderly woman’s house didn’t need shingles.
2.Not only was her roof in good condition, the quoted price was about twice what it should have been.
3.Since there was no grade of shingles specified, the roofer was free to put on the cheapest grade he could find. In the end, the woman ended up with a worse roof than what she started with.


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Fraud type I: The repairman/free inspection One of the most common frauds that is perpetrated on seniors is one that is committed by those who wish to perform upgrades or repairs on or within the home. Seniors are often short of or trying to retain their cash and are fearful of impending consequential damage.

They also want to maintain their household but are ill equipped to make certain judgments as to the necessity of such repairs. An elderly woman is not likely to follow a roof repairman up on top or navigate the crawl-space to determine the integrity of the foundation. Even if she did, she probably doesn’t have the expertise to determine the accuracy of the assessment. A fraudulent contractor depends upon these facts.


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Fraud type II: The willing participant Another type of contractor fraud actually pulls the homeowner in on the scam. The contractor usually approaches potential victims whose homes are in need of repair and suggests that he can help them get their home repaired at no cost. It sounds simple.

The contractor comes in and creates additional damage to the property and tells the homeowner to file a claim with the insurance company, saying that wind, hail, broken pipes, or some other accident damaged the property.

The contractor and homeowner agree that in exchange for the contract, the contractor will perform all repairs and not charge the homeowner the deductible.

Again, it sounds simple. The homeowner gets a much needed repair done at the expense of the insurance company who would never miss the money anyway. In essence, it is thought that there is no crime or victim. No foul, no harm? Hardly!

What isn’t explained to the homeowner is that by signing a fraudulent claim, they in fact are committing a crime, insurance fraud. Insurance companies are often hit this way and are taking this problem very seriously. They will prosecute, and guess who they will prosecute. Not the contractor. He has given an estimate that doesn’t indicate anything illegal and can easily place all the blame on the homeowner.

Filing a false claim with an insurance company is serious business and doing so can cause unbelievable hardship. Insurance companies are also on the lookout for such scams and they are experts at finding them. The name of the contractor alone could trigger an investigation.

If you run into one of these shysters, get far far away!


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Fraud type III: Take the money and run These contractor swindles are quite prevalent and yet it’s so easy to stay out of their way. Merchants who have been in business and want to stay in business seldom run these scams. It usually starts with a knock at the door by someone claiming to be a contractor who is doing work in the neighborhood and willing to work quickly and cheaply.

The scam comes when he claims to need money to go out and pick up the supplies but will be right back. He even says that he doesn’t want complete payment until after the job is completed.

The problem? He never comes back with supplies. Occasionally, these guys even start some demolition work before they leave, but once the money is in hand, they’re gone. Not only are you out the money, but they’ve often left damaged property behind which may cost more to repair than the original job would have.

Avoiding these scams is easy. If you need work done, call a legitimate contractor instead of trying to save a few dollars. Make sure that you get a written estimate or proposal and make sure that you fully understand the terms before you agree to anything.

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Old 07-12-2011, 07:25 PM   #3
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Fraudulent Insurance Issues


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Old 07-13-2011, 08:29 AM   #5
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Fraudulent Insurance Issues


Happens after every hail storm. The storm chasers acting like roofers come and steal steal steal. Buyer Beware, there is no such thing as a free anything.
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Chicago Roofing Chicago Gutters

Sometimes the savings that comes from doing it yourself can be blown away with one mistake.

The information found in this post is not to be considered legal advice. All information should be considered relative, not specific. Never attempt any repairs you are not comfortable with. Always maintain safety! The author of this post takes no responsibility for any losses that occur. Use at your own risk.
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