Auto Fraud: PIP claim fraud for dummies – how not to do it

The insured took out a policy for his Jeep; three weeks later he removed the Jeep from the policy and added an older Honda. A month later, he reported that while driving the (now-uninsured) Jeep he was involved in a multi-car rear-end collision, with neck and back pain. Other passengers were injured, he said.

Red flags were raised immediately: the insured was uncooperative; there was no evidence of vehicle damage; a possible stuffed passenger accident was suspected; additional household residents weren’t listed on the policy, which was a loss on new business.
Our investigation confirmed:

  • The Jeep was indeed removed from the policy prior to the accident
  • The insured’s daughter and wife indicated he had not been involved in an accident and had no injuries
  • Two injured passengers were involved in one or more additional fictitious accidents under SIU investigation and reported to NICB (National Insurance Crime Bureau)
  • A third passenger, according to online newspaper reports, was incarcerated at the time of the accident, arrested in a home invasion and charged with first degree murder in the beating death of the resident
  • Medical records reviewed shows that all were being treated with medical mill providers submitting inflated billings, possibly for non-provided services

Claim denied. Potential cost savings: excess of $37,500.