Wrong Time for a Career Change

Jo Blackmore of Van Nuys was arrested on workers' comp fraud. The 55-year-old real estate agent continued to work while receiving disability benefits.

According to CDI fraud investigators, on April 28, 1998, Blackmore filed a workers' comp claim with State Farm Insurance Company alleging that she suffered an injury to her right hand. At the time, she was working as a hair stylist for Cost Cutters in Saugus. As a result of the claim, Blackmore was placed on total temporary disability from April 29, 1998, through Oct. 28, 1998, and was awarded temporary disability benefit payments during those six months.

During two separate medical exams, Blackmore told her doctor that she had not worked while on disability; however, the investigation revealed that Blackmore had worked as a real estate agent during her disability period and had received $6,777 in real estate commissions during that time.

Taking a Bite Out of Fraud

Thanks to the Arizona Department of Insurance Fraud Unit, the Department of Public Safety, the Phoenix Police Department, and the help of a forensic odontologist, a 30-year-old Phoenix man with a broken front tooth who is suspected of staging numerous slip-and-fall accidents was arrested and charged with insurance fraud.

According to Fraud Unit Chief Terry Cooper, several slip-and-fall accidents have occurred in restaurants and department stores throughout Arizona during the past year. In each case, the subject uses a different name. In this case, the suspect is identified as Barney Miller.

Cooper explained that usually two or more subjects would enter the restaurant or store, and one would go into the restroom and loosen plumbing pipes causing water to spill onto the floor. Moments later, he would come out of the restroom claiming water on the floor caused him to slip.

In this case, the subject further claimed to have sustained an injury, hitting his mouth on the counter and/or fracturing his right hand. After seeking medical attention at a local hospital and dentist, the suspect would file a claim with the business' insurance company.

The Insurance Fraud Unit began matching the claims with X-rays taken of the subjects' teeth. The fraud unit contacted Dr. John Piakis, a local forensic odontologist. The X-rays revealed that all of the claims were made by the same individual.

On March 24, Miller was taken into custody when he picked up his insurance check. His teeth were then X-rayed and were matched to the individual making the fraudulent claims.

Miller and others are believed to have received several thousand dollars in payment for fraudulent claims.

Timing is Everything

The Department of Consumer and Business Services (DCBS) revoked the individual and corporate insurance agent licenses of Eugene P. Hamilton of Portland for defrauding an insurer and other violations of the Oregon Insurance Code.

On July 12, 1997, an 18-year-old woman leased a car from Gladstone car dealer, but because she didn't have enough money for the down payment and insurance, the dealer agreed to pay her first month's insurance and contacted Hamilton to arrange coverage for the customer.

The following day, the woman caused a three-car injury accident, totaling her car. Progressive Insurance Company paid out more than $18,000 for losses sustained in the accident.

The Insurance Division of DCBS found that Hamilton hadn't arranged coverage until July 14, yet he backdated the application to make it appear the policy was in effect when the accident occurred. In addition, he convinced the young woman to tell Progressive that she had personally met with him at the dealership on July 12 and signed the insurance application.

Hamilton was fined $2,000 for failing to properly respond to the division's requests for information, and his agency, AA Associates Insurance Agency, was fined $1,000 for failing to notify the division of a name change and failing to notify the division when it affiliated or terminated several agents.

No License, No Joke

The Department of Consumer and Business Services (DCBS) revoked Brian K. Dusenberry's insurance agent license for violations of the Oregon Insurance Code. DCBS also revoked the firm license of Fairway Insurance Agency, Dusenberry's Woodburn agency.

According to an investigation by the Insurance Division of DCBS, Dusenberry had transacted insurance since July 1995 without being licensed as an Oregon individual insurance agent.

In addition, Fairway Insurance Agency violated Oregon law by transacting insurance without an agency license and by authorizing Dusenberry to transact insurance on its behalf.

Flea Markets are No Place to Buy (or Sell) Insurance

Nevada's Division of Insurance (DOI) state officials uncovered a scam in which flea marketers in Clark County were selling proof-of-auto insurance cards for $100 a piece.

According to Betty Baker, insurance counsel and hearing officer for the Nevada DOI, the phony agents/flea marketers were allegedly selling stolen blank insurance cards or legitimate cards that had been altered and reprinted.

To date, the DOI has confiscated roughly 100 cards before they were sold to consumers. Consumers who purchase these phony cards are in violation of state law requiring auto insurance and if they are involved in an accident, they are legally liable for damages as a result of that accident.

A similar situation recently took place in Lousiana, where consumers were fooled by several agents selling worthless coverage. The agents were not licensed in Lousiana, and therefore the coverage was not binding.