Calif. Sweep Nets Four Fraud Suspects

Starting Feb. 24, investigators from the California Department of Insurance's Fraud Division conducted joint operations in the Central Valley to execute outstanding arrest warrants.

CDI partnered with the Fresno District Attorney's Office, Fresno Police Department, and the Tulare County District Attorney's Office for operations in Madera, Merced, Fresno, and Tulare Counties. Victor Aguilar, of Merced; Gloria Cortez Keene, of Merced; Kimberly Elaine Knight, of Fresno; and Steven Rodney Upshaw, of Madera were arrested Feb. 24. If convicted, each suspect could face five years in prison and/or a maximum fine of $50,000.

In the first case, Aguilar was charged with two felony counts of insurance fraud and grand theft. In December 2004, the California State Automobile Association's Special Investigation Unit advised CDI of a call from a victim in a domestic violence case who stated that her boyfriend, Aguilar, had made a fraudulent insurance claim regarding the burglary of his residence. Investigators subsequently recovered a large amount of furniture and other items which had been claimed as stolen.

Investigators reportedly later determined that Aguilar reported the burglary after a previous domestic violence incident which caused his girlfriend to move to a domestic violence shelter. When the victim moved out, Aguilar accused her of taking his personal property. The victim stated that the items which he reported stolen were actually hers; when she moved out she placed them into storage.

However, Aguilar allegedly discovered the location of the stored items and returned them to his residence prior to concluding his insurance claim. Nevertheless, Aguilar reportedly completed his insurance claim and was paid approximately $2,400 for the items by CSAA.

In the second case, Keene, a former member of the Merced County Board of Supervisors, was arrested for auto insurance fraud. She faces two felony counts of presenting a false or fraudulent claim and presenting a false statement regarding an insurance claim. The case is being prosecuted by the Sacramento County District Attorney's Office.

This case was referred to CDI by United States Automobile Association Insurance, who suspected fraudulent activity in an automobile claim filed by Keene in 2003.

USAA paid $2,500 for the collision damage on a claim that allegedly occurred on Jan. 20, 2003. During the investigation, however, information surfaced that the damage reported by Keene was the same damage observed on the vehicle when it was owned by Keene's daughter, Julie Valdez. An independent witness reportedly stated that the damage originally appeared on the vehicle on Feb. 19, 2002, and was reported to USAA by Julie Valdez as having occurred on April 19, 2002. Valdez is currently facing insurance fraud charges in Merced County. Keene allegedly added the same vehicle to her policy on Oct. 28, 2002, and reported the alleged, Jan. 20 loss on June 11, 2003. A comparison of the damage showed it was the same damage.

In the third case, Knight and Upshaw were both charged with three felony counts each of insurance fraud, willful destruction of insured property, and presenting a false insurance claim for auto theft.

Wash. DOL Fines Contractor over Workers' Comp Violations

The Washington Department of Labor and Industries has put Skanska USA Building Inc. on notice that it will lose its certificate to self-insure if it doesn't improve the way it manages workers' compensation insurance claims.

In addition to the "corrective action," L&I issued the largest fine ever levied against a self-insured employer, assessing Skanska USA $136,264 in penalties for its mismanagement of workers' comp claims over the past six years. That is in addition to the $124,811 an L&I audit found the company underpaid injured workers who did file claims.

Skanska began taking steps to correct deficiencies in its handling of claims, but has exercised its legal rights by protesting the audit findings. L&I has asked the company for records that support its contention that some of the audit findings are wrong.

Skanska AB is headquartered in Sweden. Three years ago it purchased Baugh Construction Co. An L&I audit of the firm found that under both ownerships, the company failed to provide forms to file workers' comp claims to at least 468 workers who were injured on the job. The violations date back to 1999. Workers told L&I investigators that company officials threatened to fire them, or not hire them back on other jobs, if they filed a workplace injury claim.

Washington state law allows companies that meet established financial and safety criteria to manage their own workers' comp claims.

In addition to the fine and back payments, Labor and Industries will closely monitor Skanska's management of its workers' comp claims to ensure the company has corrected its practices and is in compliance with the law. The agency will take steps to revoke the company's self-insurance status if it doesn't manage claims properly.

Brothers Arrested in Auto Premium Scam

Carlos Vasquez-Marquez and Jose Miguel (Mike) Marquez, of Rancho Palos Verdes, Calif., have been arrested and charged with seven felony counts of grand theft. The arrests are the result of a 20-month investigation conducted by CDI.

The investigation found that Carlos Vasquez-Marquez, a licensed broker/agent and owner of Unitrans Insurance Services of Wilmington, along with his brother Mike, who is unlicensed, allegedly collected insurance premiums and failed to provide coverage to their clients.

The Marquez brothers allegedly collected over $18,000 in premiums from seven victims over an 18-month period before their arrests on March 3. They were booked into the Los Angeles County Jail and released March 5, posting bail of $160,000 each.

Commissioner John Garamendi said that the Marquez brothers targeted Latino truck drivers in the Los Angeles area, collecting premiums and leading the drivers to believe they were receiving bonafide commercial trucker policies. The premiums were allegedly never submitted to insurance companies.

In an effort to make the policies appear legitimate, the brothers allegedly used real insurance company names that specialize in providing insurance to the trucking industry. Insurers included Liberty Mutual, Sutter Insurance Company, General Security Insurance, TOPA Insurance, Adriatic Insurance and Ranger Insurance Company.

Carlos Vasquez-Marquez, after being contacted by Department of Insurance investigators, decided to return the premium money to the victims. The brothers face seven charges of grand theft.