Fraud

The Adler Law Group, although based in Los Angeles, assists insurance companies with fraudulent and suspicious insurance claims throughout the United States.

Fraudulent (and Suspicious) Claims

Putting individual pieces together to form a larger pattern is the basic philosophy of the Adler Law Group in handling a claim which raises "red flags."  Plainly, an insurance carrier, after it investigates a claim, must pay any claim which is legitimate.  Increasingly, however, insurers are being confronted with suspicious claims which may be fraudulent, in whole or in part.  Further, the fraudulent claims now appear to be more and more complex.  Because of the faltering economy, separating the legitimate from the fraudulent is of greater importance than ever before, but the volume and complexity of such claims is increasing.

Every claim presents some pattern. Much like the adjacent picture, however, a fraudulent claim may initially present an extremely complicated set of facts and legal issues when the claim is first presented.  Thus, no general pattern can be initially seen by the claims handler.  Further, unlike similar claims of even a few years ago, this level of complexity continues to increase.  That is so, for among other reasons, because the policyholder can now "manufacture" documents in whole or in part.

While the insurance industry has dealt with fraudulent claims for over two hundred years, the insurer's review of the most recent batch of claims is complicated by the policyholder's ability - as the result of access to the wonders of desktop publishing - to prepare "false" documents which appear to be genuine.  Additionally, those "manufactured" documents may bear the well-known trademarks, logos, and formatting of genuine invoices and legitimate statements of banks and credit card companies.

In this context, the Adler Law Group is familiar with the legal principles involved and has utilized creative techniques to investigate suspicious claims.  These efforts have resulted in supportable conclusions that various claims were fraudulent.  Where the claims initially appeared suspicious, but were determined to be genuine, the Adler Law Group has rapidly recommended the carrier pay the claim to avoid any potential bad faith claim.

In short, by investigating a large group of individual documents, facts, and circumstances which initially appear to be random, the Adler Law Group has been able to dig out a controlling pattern.  Regardless of the complexity initially presented, the firm has generally been ultimately able to find a pattern in the chaos - just like the accompanying picture incorporates the seemingly random pattern of the wood inlay into the larger image of a clock.  Our three decades of experience in investigating such claims has resulted in our revealing various claims, such as the following, were fraudulent:

• A supposed "theft" of jewelry from a policyholder was found by the Adler Law Group to have been the subject of an earlier theft claim presented to (and paid by) another insurance carrier.  The lawyers also discovered the "stolen" jewelry had been insured by a third insurance carrier after the "theft."  The policyholder thereafter voluntarily dismissed her lawsuit for breach of contract and bad faith.

• A supposedly accidental fire burned an insured's warehouse.  The policyholder presented a financial statement (and related financial records) prepared by its CPA to indicate it had a credible amount of income.  From those records, the insurance carrier inferred the insured had no financial motivation to set the fire.  The lawyers, however, then obtained a second statement (and related financial records) for that same time-period; these records showed the insured as being in a dire financial condition (and apparently prepared to avoid penalties for under-reporting of income).  The insured dismissed its breach of contract/bad faith case after the second set of records became the basis for the carrier's motion to compel production of the insured's tax returns. 

After handling such claims for insurance carriers for over twenty years, Erwin has recently been appointed by a major insurance carrier as its consultant on a nation-wide basis.  In that capacity, he will provide guidance to its claims handlers wherever a suspicious claim of sufficient size is presented anywhere in the nation.