Wednesday, July 29, 2009


After noticing reoccurring suspicious claims activity with a large retail operation customer, Zurich in North America’s Claims and Special Investigations Units sprung into action, busting a “slip and fall” fraud ring.

The work of Zurich’s Claims and special investigators helped federal postal inspectors unravel a scheme involving 33 individuals in Illinois and Wisconsin, who filed at least 60 claims with 16 insurance companies, including Zurich.

“We believe this scheme began in August 2005 and was still active until February 2009,” said Brian Wilson, vice president of Zurich’s Special Investigative Unit. “Shutting down these fraud rings sends a clear signal that we are watching for fraudulent activity, and ultimately benefits our customers in the end by keeping their premiums lower.”

The group struck “big box” retailers, sometimes as frequently as two and three times a day. The scheme involved staging slip and fall accidents in a store. One individual set up the accident with liquid or paper on the floor, while another staged the fall. Others acted as look-outs, making sure no store management witnessed the “accident,” and then informed store officials of the incident.

Claims were filed under the retailers’ medical payment portion of their policy, meaning checks were typically mailed directly to the claimant. Each claim was in the $4,000-$8,000 range.

While the vast majority of insurance claims are honest and legitimate, the Coalition Against Insurance Fraud statistics show 10-15 percent of all claims contain some element of fraud.

  • Ohio Department of Insurance Director Mary Jo Hudson announced that an earlier Cease and Desist order issued against The Beema Insurance Company of Pakistan has been made permanent.

    A Department investigation revealed that The Beema Insurance Company did not have a license to sell insurance products in Ohio. Beema had allegedly underwritten health insurance policies facilitated by Association of Franchise and Independent Distributors (AFID) of Springfield, Ohio. The original Cease and Desist Order was issued in early June 2009.

    AFID has already had a Cease and Desist Order filed against them by the Ohio Department of Insurance, who has referred the matter to Ohio Attorney General Richard Cordray for further investigation.

  • The North Carolina Department of Insurance has already issued a cease and desist order against both entities as well.

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