Category Archives: Claims Investigations

This was a questionable claim as the policy had reinstated the same day as the loss.

Further questions arose when the claimant stated she knew the insured (they went to school together) but had not seen the insured in a long time. The claimant provided cell phone photos via email. The date and time stamp properties of the photos were checked and it was determined that time of the loss was approximately 15 minutes prior to the policy reinstatement.

Consequently, no coverage was afforded for the collision, property damage and reported injuries.

Awake at the Wheel

The insured driver stated she fell asleep and hit a center median. It was noted that loss occurred within 10 days of the inception of the policy. Ultimately, we receive an update from the California Department of Insurance District Attorney’s office that both insureds on this policy were arraigned for insurance fraud.
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Internal Combustion Cabin

The insured owned a luxury 2014 truck with a $700 per month payment to match. Unfortunately, she was having difficulty getting the vehicle registered in California. The insured claimed that she parked the vehicle at the residence she shared with her mother before returning to a complete interior burn. Based on forensic evidence alone, the…
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The insured submitted a claim for “stolen” and then “recovered” burned vehicle. The initial claims adjuster secured the insured’s recorded statement in which he admitted being behind on his car loan payments.

The police report noted the loss was suspicious. There were inconsistencies in the insured’s timeline based upon his cell phone activity. When questioned further, the insured advised the attorney that his 6 month old daughter must have gotten a hold of one of their phones and kept hitting the last number called. However, the cell phone towers did not support the insured’s statement.

Further follow up with the police resulted in a reopened investigation. The detective secured a video confession of the insured admitting he made it look like his vehicle was stolen before setting it on fire in a fraudulent attempt to claim a total loss and elude the financial responsibilities of his car payment.

The claim was denied due to the insured’s intentional act as excluded by the policy. The success of this file started with a detailed recorded statement. The value of the vehicle was over $15,000.

This matter has been referred to the DA’s office for potential further action against the insured.

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