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Last Post 07/31/2007 3:55 PM by  Dimechimes
NAIC Draft copy of l Independent Adjuster Model Licensing Act
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Ray Hall
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04/04/2007 1:48 PM
This is blockbuster news, I have only heard about 3 or 4 cases of judges in my time. You hear about insurance fraud rings; but the plaintiff attorneys appear to be duped also. This may the biggest case I have ever heard about.
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Tom Toll
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04/04/2007 6:55 PM
Fines of $500,000.00 and $750,000.00. Why is the insurer not entitled to a full return of their millions of dollars in settlements. Glad to see these folks were caught, but makes me sad they are of our judicial system.
Success is not final, failure is not fatal: it is the courage to continue that counts.
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Gale Hawkins
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04/05/2007 4:00 AM

Debbie, it has been a long day but I could not pass up a quick reply. This case against the judges is wild. What people will not do for a short term gain and long term loss?

 

While we know there are problems from time to time with staff actions at the carriers and that will always be the case I was just thinking yesterday about researching the billions home owners have stiffed the carriers for over the years and posting that info but looks like fraud against the carriers made the headlines before I could act.

 

It seems like actually a homeowner can get justice easier than a carrier can when they are wronged by the homeowner. Keep the links coming so we can see these issues are a two way street.

Tom makes a good point about where is the carrier's money?

 

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Gale Hawkins
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04/11/2007 1:14 PM
Some links that talk about what homeowners do in the way of fraud. The one survey that states 25% think it is ok to defraud insurance companies I find disturbing. One can only wonder how this view that the carrier is the fat cat and deserves to be taken to the cleaners came to be. While mistakes can be made by all parties this has to get old for these staff adjusters seeing it day in and day out yet not to be able to do a lot about it in many cases due to the lack of evidence that will stand up in court. Knowing something and proving something are two different things.
 

As some other post indicate the news media and the high profile can make a lot of news by claiming wrong doing but the carriers who are under daily attack by their own customers often have their hands tied because it they go out making wild accusations then they can be sued. 

Maybe the IA Model Licensing Act will meet its objectives but if many homeowners view ripping off carriers as being OK that fact has to make life harder for both the adjuster and carrier.

 
Seven Arrested in Homeowner Fraud Case
News Release Date: 6/27/2002
Category:   Fraud
Seven people were arrested today in Houston in connection with an insurance fraud scheme in which homeowners allegedly intentionally flooded their homes and filed claims that cost insurance companies about $5 million.
"It´s unfortunate that individuals would try to take advantage of homeowner insurance policies when we´re already facing rising rates because of water and mold- related claims. Let these arrests be a warning to others that filing fraudulent insurance claims will not go unpunished," Texas Insurance Commissioner Jose Montemayor said. "Insurance fraud hurts all of us. The financial loss starts with the insurance companies but eventually it is paid out of the pockets of every Texas homeowner."
 
Make your fraud report by calling our toll free number, 1-800-259-5300, and asking for the Fraud Unit, or by calling the Fraud Unit directly at 225-342-4956. Or, fill out your report on the Internet by going to our website, www.ldi.state.la.us, and
clicking on Report Fraud.
 
 
http://www.insurancejournal.com/news/southeast/2005/06/20/56303.htm
Fla. Investigators Encounter Increased Fraud as an After-Effect of 2004 HurricanesBy Dave Kaiser
June 20, 2005
Insurance fraud has increased dramatically in Florida as an after-effect of the 2004 hurricane season Robert Elliott, a lead investigator with Nationwide Insurance's Special Investigation Unit told law enforcement investigators, special investigation unit investigators, attorneys and claims adjustors attending the Annual Florida Insurance Fraud Educational Committee meetings last week in Orlando, Fla.
http://www.insurancefraud.org/releases_2001.htm several articles on the subject
http://www.bls.gov/oco/ocos125.htm
Claims Adjusters, Appraisers, Examiners, and Investigators
*                     Nature of the Work
*                     Working Conditions
*                     Training, Other Qualifications, and Advancement
*                     Employment
*                     Job Outlook
*                     Earnings
*                     Related Occupations
*                     Sources of Additional Information
 
Significant Points
*                     Adjusters and examiners investigate insurance claims, negotiate settlements, and authorize payments; appraisers assess the cost or value of an insured item; investigators deal with claims about which there is a question of liability and where fraud or criminal activity is suspected.
*                     Licensing and continuing education requirements vary by State.
*                     College graduates have the best opportunities; competition will be keen for jobs as investigators, because this occupation attracts many qualified people.
http://newsroom.accenture.com/article_display.cfm?article_id=3970
12 February 2003
One-Fourth of Americans Say it’s Acceptable to Defraud Insurance Companies, Accenture Survey Finds
NEW YORK; Feb. 12, 2003 –Nearly one in four U.S. adults say that overstating the value of claims to insurance companies is acceptable, and more than one in 10 say they approve of submitting insurance claims for items that were not lost or damaged or for treatments that were not provided, according to a survey released today by Accenture.
http://www.statefarm.com/about/media/backgrounder/insback.asp
Insurance fraud: everyone pays the price
·                                 What Is fraud?
·                                 Who commits fraud?
·                                 Common fraud schemes
·                                 Increased emphasis on fighting fraud
·                                 What are insurers doing?
·                                 What can people do to help fight fraud?
·                                 Antifraud efforts need public support?
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Ray Hall
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04/12/2007 1:38 PM

The "Mold Gold" of 1999 to 2003 in Texas was an area when all insurance carriers lost their minds, also thier gonads and spines.  This myth cost several billon that should not have been paid in fraud claims and several million more in investigation, testing, and out landish payments for common labor to carry sheetrock to a dumper in a tyveck suit.

I was right in the middle of it from start to finish. Not one insurance company in the United States said NO. Some of the London type did fight the good fight and won.

Unfair claims practice laws changed the way first party claims have been settled since the middle 90,s. I say settled you can not settle a doubtful and disputed first party claim today, because you are afraid of the trap of  UCP laws burning you to the stake on the under lying case. It seems the carriers have been put in a position of not able to work out compromise settlements any more. The thinking is you "owe all of it or none of it."

This appears to be the thinking and the main cause of the Katrina " slab house" cases "all or none".  We (the claims departments) did not use this hard stance until UCP laws were inacted in each state. We will have to cry out like the medical doctors on malpractice caps to get this train back on the track.

The major problems on catastrophe losses today is the grey area claims can not be settled as doubtful and disputed (causation) (amount) as this is prima facia evidence on the UCP claim.

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Dimechimes
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04/21/2007 12:41 PM

The NAIC subgroup now has 2 new Drafts from 3-16-07 and 3-22-07 as well as some comments posted by the 4-6-07 deadline to comment on these drafts.

http://www.naic.org/documents/commi...el_act.doc

Some interesting things noted in this updated draft include(but not limited to):

Info about the fingerprinting being run through the FBI National Criminal history check

Section 11-C.7.-says those under the Apprentice license can only receive compensation either as salary or hourly compensation(apparently no fee schedule payments...I wonder how the IA firms and carriers will handle this???)

Section 12 # 11- see discussion about revocation due to child support payment delinquencies

I haven't put the Dec 06 draft(which I initially provided a link to at the beginning of this topic) next to the 3/07 draft to compare all differences yet but will try to do so in the next couple of weeks.

In addition, there is a 3/22/07 draft:

The March revision above was dated 3-16-07 and here is an even more updated draft of 3-22-07.

http://www.naic.org/documents/commi...070322.doc

Something interesting unless I missed it is I don't see the 20K bond info in these new drafts-let me know if anyone sees it.

A few things that stand out in this 3-22-07 draft are:

Sect 4- see who is exempt from needing a license: "managers who don't investigate,settle,etc and admn mgrs,etc

Sect 5-See insurer reporting requirements for emergency adjusters- it includes many items but one I've never seen or been required to report before is the Date the insurer and independent adjuster contracted to work together

Sect 12-see info on the Business entities and the duty it looks like it's imposing on business partners, officers, and managers being required to report violations of Indp Act to commissioners. It looks like their Individual licenses would be at risk if they fail to report violations to Ins dept

Sect 14-Clarifies that the copies of the claim files/communications are required to be kept by the Indp( some have told me they thought the IA firm keeping the files would suffice- that is not what this section says-it is very clear the duty is on the Indp

Section 15-
Be sure to read the Standards of Conduct

Here is the link to the web page on the committee:

http://www.naic.org/committees_d_pl...bgroup.htm

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Betrock
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04/27/2007 1:16 PM

I just finished reading the IALMA draft dated 04/24/07, as well as the memorandum.

 www.naic.org/committees_d_plwg_independent_adjuster_subgroup.htm

I agree, there is no mention of a bond.

Posted By Deborah Moroy on 04/21/2007 12:41 PM


Something interesting unless I missed it is I don't see the 20K bond info in these new drafts-let me know if anyone sees it.

The real voyage of discovery consists not in seeking new landscapes... but in having new eyes. -Marcel Proust
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Dimechimes
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07/31/2007 3:55 PM

The NAIC Model Independent Licensing Act has been dropped. The last draft had been 4/24/07 with expected passage by June 2007. New regulations pertaining to all Model Acts changed the passage of this act and future activity according to the Spring 2007 newsletter (here)by the American Association of  Independent Claim professionals. The Winter edition had given the information on the expected June passage and can be found on the same link.

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