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Posted By stormcrow on 12 Feb 2012 10:40 AM
Sleazy yes  fraud, in my opinion no. There is no rule I know for to stop a contractor from over bidding. But, is the insurance company is using a 21 college grad who does not know a ball peen hammer from a brad nail and do they blindly pay this because they are to cheap to hire real adjusters. The  ones who suffer are the policy holders, who will pay more. I drive contractor crazy  be demanding a detailed subtrade bids. You shold here the excuses!  Greed does not seem to be illegal, in fact it has become a normal part of business, no profit is obsene.

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Stormcrow, the keyword here can be found in the following sentence (your words) "There is no rule I know for to stop a contractor from over bidding".

1) The salesman to which works for this company and started a ficticious company is NOT a contractor.

2) The female employee who is taking bids from real contractors is then "pulling numbers out of the air" with no actual knowledge of ANY real job costs and writing a false estimate under a ficticious company name for "obscene profits"

Chuck is right in that when jobs are bid, the difference in bids can be astronomical. I have been a licensed/bonded concrete contractor in the state of California since I got out of the Army in 1992 (albeit I have not lifted a shovel nor have I done a bid in close to 7 years . As a contractor I have the knowledge and the right to bid whatever I want to. The homeowner has the discretion to either accept my bid or not, however the homeowner rightly has the belief that any bid received is from an equally knowledgeable licensed/bonded contractor. Atleast in California, it is against the law for an unlicensed person to submit any bid over 400.00. Stings are an often occurance and the unlicensed are forced to pay dearly in money and jail time.

So for this woman to falsely submit a bid to an insurer under the guise of a legitimate business (regardless whether said state requires contractors to be licensed or not) is fraud. She is attemting to make the carrier believe that the company name on the bid is in fact a real contractor and by association herself as a legitimate authority to which BOTH are neither an actual company nor a legitimate authority

Posted By Leland on 12 Feb 2012 04:34 PM
I would like to point out that there is a difference between common law fraud and statutory fraud. In a civil case I believe the standard is the common law fraud I explained above. When the State prosecutor goes after an individual for insurance fraud, the charge is based on a statute. It is a crime against the state, not a private party. The statutory definition of fraud is different than the common law definition. It might be a lower standard, I'm not sure. I just know that there are always certain elements that must be proven. What the person on the street thinks is a fraud may or may not meet the legal definition. And furthermore, as Chuck points out, proving it is altogether another step.

Notice that she appears to have been sued by the insurance company AND the Federal govt.

She also counter-sued the insurance company for defamation. Hopefully for the adjuster's sake he didn't use the word "fraud" in his written report so he could avoid being a defendant in the counterclaim.

As an adjuster go ahead and write down that the expert says the diamonds are fake. Go ahead and write down that the insured swore they were real. Just don't use the F word and you will stay out of unnecessary trouble. Leave that determination to the lawyers and police that are paid to do that

 

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Leland, your post is very thoughtful and backed up with proven facts. In particular, your last paragraph cannot be overstated. In addition, to the next generation of adjusters who read these boards and take what they read as gospel.

My very first year during Jeanne in 04, there was another young adjuster working, it was his second year I believe. He was on a claim in Homestead, Fla and apparently the insured offered the adjuster a couple grand to up the ante' (so to speak) Well this kid told the insured that is a bribe and something he cannot do. He left it at that and finished up the scope and went to the next risk. (he did NOT report this to his team lead or claims manager) Well the insured panicked and reported to the police that the claims adjuster offered to up the claim for a bribe. A big deal was made and an investigation was implimented. Granted in the end , the kid kept his job and the insured never went to jail (or anything for that matter). However, that showed me that if it happens, you have to be careful in how you react and just like you said Leland, even if you know something is fraudulant, it is not in our best interests to either confront the insured or even write ANYTHING stating as much ( as emails/claims documentation are discoverable and you could be held liable for using the F word). To the new folks reading these posts,you should keep your thoughts/opinions to yourself and notify your immediate supervisor ASAP upon leaving the site

Posted By ChuckDeaton on 12 Feb 2012 11:13 PM
Robbie, you keep saying that this example represents fraud.

I copied portions of documents related to fraud claims that I've been involved in.

Please post documents that support your position that simple puffery is actionable fraud.

 

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The people writing these estimates are not contractors, they are restoration employees "claiming" to be contractors. It would be different if these people submitted said estimates under XYZ Restoration. But they are not. If there is nothing fraudulent about this estimate, then why are they using a fictitious LLC to do so? 

They are trying to fool the carrier into believing that said supplemental estimate is from a legitimate contractor when it is NOT. 

Chuck, I am a legitimate contractor and have been since 1992 . Based upon what has been written in this thread, these people are liars and thieves