Maryland Insurance Administration Issues First-Ever Civil Fraud Orders

The Maryland Insurance Administration on Tuesday issued its first administrative orders under newly granted authority to pursue civil cases of insurance fraud.

The authority took effect last October following passage of legislation by the 2012 Maryland General Assembly. Previously, the agency investigated only criminal fraud cases, which are prosecuted by either State’s Attorney’s Offices or the Office of the Attorney General. Fraud referrals made to the agency’s Insurance Fraud Division since October 1, 2012, are now also reviewed for civil remedies.

Orders were issued in two separate cases. The first involved a Baltimore woman who submitted falsified documents to two insurance companies, saying she had missed eight days of work following a February 2012 automobile accident.

The woman was found to have used her employer’s signature stamp without his knowledge to validate her claim of lost wages. An investigation led by Assistant Chief Civil Fraud Investigator Joe Smith of the Maryland Insurance Administration found that the woman had not missed any days of work after the accident. She has been ordered to pay a $2,000 fine and reimburse State Farm Insurance Co. for the $644 payment it made to her as a result of her false claim. The other insurance company learned of the false information in time to stop payment on her claim.

The second case of fraud involved a Mechanicsville man who filed a disability insurance claim with a false date listed for his return to work. As a result of the false date, the insurance company paid him for time during which he also received a salary from his employer. The man has been ordered to re-pay $1,120.70 to American United Life Insurance Co. and pay a $2,000 administrative penalty.

The Maryland Insurance Administration notes that losses from fraudulent claims are passed on to all consumers in the form of higher premiums. The Coalition Against Insurance Fraud estimates that theft through insurance fraud reaches at least $80 billion each year.

An independent state regulatory agency, the Maryland Insurance Administration regulates Maryland’s $26 billion insurance industry.

Source: Maryland Insurance Administration