Some people might call a car accident a bit of bad luck.
Others see it as a meal ticket to a brand-new life.
While there are no precise numbers on the amount of auto
insurance fraud committed each year, the
Insurance Information Institute
(III) estimates that about 10 percent of all property and casualty
industry losses are due to fraud. Those cases range from the guy
who gets in an accident and claims he injured his back -- when he
actually strained it taking out the trash -- to organized gangs
that stage wrecks and then milk auto insurance companies for every
penny they can.
"There's always going to be people walking among us that follow
a different path," says Frank Scafidi, a former FBI agent who now
is spokesman for the
National Insurance Crime Bureau
(NICB). By committing insurance fraud, "it's easier for them to
strike pay dirt."
"Insurance fraud is very low risk and very high gain," Scafidi
says, particularly compared with robbing a liquor store or selling
a kilo of cocaine on the street, where crooks run the risk of being
shot or being sentenced to significant prison time.
'Soft' fraud shades the truth
The III classifies fraud as "hard" or "soft." When it comes to
auto insurance, hard fraud is a deliberate attempt to stage or
invent an accident or other type of incident that results in a
loss. Soft fraud is the exaggeration of a legitimate claim or the
misrepresentation of facts to pay lower auto insurance
David Reiss, a California psychiatrist who has examined more
than 10,000 workers' compensation and personal injury claims for
insurers, says those who fraudulently claim to be injured run the
spectrum. The majority exaggerate their injuries because they want
to "put their best foot forward to make a case."
Others aren't just exaggerating their injuries. They exhibit "a
significant degree of entitlement," Reiss says, and their claims
are "unrealistic and don't make sense."
Often those who try to manipulate the system see a claim as a
ticket out of their tough financial situation, he says. They may
feel like they've been a victim their entire lifetime, and have a
"feeling of being taken advantage of that was never really dealt
A dozen states have no-fault laws that guarantee medical
treatment up to a certain amount. Florida's limit, for example, is
$10,000. In many states, scam lawyer- and accident-referral
services and pain clinics have sprung up to make sure victims spend
every dime of that amount. (See "
Where car insurance fraud is a sport
Often those who are legitimately involved in an accident will
contact a referral service, thinking they'll receive $10,000. In
reality, they receive only token care, and the bulk of the money
goes to those ostensibly providing it.
'Hard' fraud is organized crime
That guarantee of care tempts organized fraud rings to game the
system in states with no-fault insurance laws, such as Florida and
The kingpins of these rings tend to "prey on folks within
certain minority groups," who may not know the language and laws
very well, Scafidi says. People from within these groups are paid
to stage or cause accidents. For example, they may say a wreck
occurred when it never did. Or, they may use their cars to force an
innocent driver to hit a vehicle that is occupied by a driver and
passengers on the fraudsters' payroll. After the accident, these
"victims" claim they are injured and demand compensation.
Other fraud rings simply bribe victims of genuine accidents to
exaggerate their injuries.
A single, huge fraud ring busted earlier this year in New York
allegedly cheated the state's no-fault system of as much as $275
million. Authorities say dozens of Russian immigrants pointed
accident victims with nonexistent or mild injuries toward pain
clinics and attorneys who milked the claims and trial system for
every nickel of the state's $50,000 no-fault limit.
The accident victims got $500, authorities say, but the
masterminds got rich -- groomed for their task by decades of Soviet
"This is the Russian mind-set, and this is why it's endemic in
the system," one law-enforcement official told the
New York Times
. "If you're not scamming the system, if you're not scamming the
government, you're not doing what you're supposed to be doing --
you're looked upon as a patsy."
The culprits might be Russian in New York, but they might easily
be Hispanic in Florida, Scafidi says, or South Asian in
The price? You're paying it already
The victims of phony accidents "could be anyone who looks like a
good target," Scafidi says. It's typically someone who is driving a
nice car and is likely to have good insurance.
But you don't have to be involved in a "swoop and squat" to pay
the price for fraud. Every one of Florida's insured drivers pays
about $58 a year to line scammers' pockets, the III calculates.
And in the end, injured drivers wind up cheated as well.
Florida's no-fault law is supposed to cover lost wages and burial
expenses, but the pain clinics and referral services instead make
sure medical costs use up the entire amount.
"This is money that would have gone directly to the insured but
by function of the medical provider exhausting those benefits, the
consumer receives nothing," a report by the Office of the Insurance
Consumer Advocate states.
The 12 no-fault states are Florida, Hawaii, Kansas, Kentucky,
Massachusetts, Michigan, Minnesota, New Jersey, New York, North
Dakota, Pennsylvania and Utah. The Florida Legislature recently
passed reforms it hopes will cut fraud -- chiefly by lowering the
amount of care guaranteed in nonemergency cases. (See "Florida
insurance reform: Cheaper rates ahead?") Reform bills are on the
agenda in Michigan and New York as well.