Late last month in New Castle County, a Grand Jury indicted multiple residents for insurance fraud. The indictments stem from Department of Insurance Fraud Prevention Bureau investigations, in partnership with the Delaware Department of Justice. They allege that following vehicle accidents, each indicted resident did knowingly present false information to auto insurers or otherwise caused false information to be presented.

“I want to commend our Fraud Prevention Bureau for their work identifying deceitful activity and helping to bring those who would defraud Delaware residents and companies to justice. Their efforts continue to send a strong message that fraud will not go unnoticed here, which can prevent future crimes,” said Insurance Commissioner Trinidad Navarro. “Through this work, we can help keep insurance premiums from rising by helping to make sure companies do not have to pay out fraudulent claims, and we can educate residents that engaging in fraud is very costly.”

A resident of Wilmington was indicted on September 27 following a two-vehicle auto accident and a fraudulent claim filed with Permanent General Insurance. The resident had no insurance at the time of the accident but obtained it afterward, and intentionally misrepresented the date of the accident to obtain a benefit that they were not entitled to. Video evidence was uncovered that confirmed the accurate date of the accident.

A resident of Newark was indicted on September 27 for knowingly misrepresenting the time of an auto accident. During the investigation, evidence was obtained that confirmed that the resident had no auto insurance coverage at the time of their accident and that their auto insurance policy was obtained after the accident had occurred. They engaged in insurance fraud through intentionally providing false information in order to obtain a benefit that they were not entitled to from Good to Go Insurance.

An additional resident was indicted for similar activity in an attempt to defraud Progressive Insurance. The resident obtained an auto insurance policy and filed a claim two days later, stating that their vehicle was struck by an unknown vehicle while parked at their residence. An examination of vehicle damage was inconsistent with this depiction, and the investigation further identified that the vehicle was involved in an accident three days prior to obtaining insurance coverage.

An indictment is merely an allegation and is not evidence of guilt. In all cases, defendants are presumed innocent until and unless proven guilty. Insurance Fraud is a felony.

Commissioner Navarro has a background in law enforcement and serves as Chair of the National Association of Insurance Commissioner’s Antifraud Task Force. The Delaware Department of Insurance Fraud Prevention Bureau is fully funded by annual assessment fees, not taxpayer dollars, and employs staff with extensive law enforcement and insurance investigative backgrounds and training, including credentials such as Certified Fraud Specialists and Accredited Healthcare Fraud Investigators.

The Bureau facilitates the detection of insurance fraud and works to reduce fraud occurrence through enforcement and deterrence. Additionally, the Bureau requires restitution for deceptively obtained insurance benefits, and by doing so reduces the amount of premium dollars used to pay fraudulent claims, in turn decreasing the likelihood of premium increases. The Bureau can be reached by toll free hotline (800) 632-5154, or (302) 672-7350, or by emailing fraud@delaware.gov. Reporting known or suspected fraud is free of charge and can be done confidentially.

Fraud Bureau saw a 10% uptick in reports last year

The Delaware Department of Insurance made great strides in fraud detection and response during 2019. Throughout the year, 6 criminal arrests that included 21 charges were recommended from the Department’s Fraud Prevention Bureau to the Department of Justice, and 16 civil cases were brought forward resulting in more than $21,000 in fines. The Bureau received 551 referral cases in 2019.

“I want to commend our Fraud Prevention Bureau for their work identifying deceitful activity and helping to bring those who would defraud Delaware residents and companies to justice. Their efforts continue to send a strong message that fraud will not go unnoticed here, which can prevent future crimes,” said Commissioner Trinidad Navarro. “Through this work, we can help keep insurance premiums from rising by helping to make sure companies do not have to pay out fraudulent claims.”

Commissioner Navarro, who has a background in law enforcement, served as Vice-Chair of the National Association of Insurance Commissioners’ Antifraud Task Force over the last year and has championed fraud awareness and reporting. He was named Chair of the national Antifraud Task Force last week. The Department has experienced an increase reports over the past several years, with an approximate 23% increase since 2015.

In one prominent 2019 case, a resident was arrested after posing as family member who was terminally ill and facing imminent end-of life to open a life insurance policy. This was conducted through forgery of the family member’s identification, confirmation, and consent. After naming themself the sole beneficiary, the individual then attempted to collect $50,000 on the policy two days after the family member’s death. Charges included insurance fraud, identity theft, second-degree forgery, and crime against a vulnerable adult.

From identity theft to insurance healthcare fraud, hundreds of tips are investigated every year. In 2019, the most common schemes were seen through the application for auto insurance process, with individuals living outside the state attempting to save on premium costs by using Delaware addresses. Suspected to have risen due to possible economic factors, instances of application submissions occurring after an accident took place also grew. In addition to investigating tips from the public and insurance companies, the Bureau works with law enforcement in locating life insurance policies in death investigations.

The Fraud Prevention Bureau is fully funded by annual assessment fees, not taxpayer dollars, and employs 13 fulltime staff with extensive law enforcement and insurance investigative backgrounds and training, including credentials as Certified Fraud Specialists and Accredited Healthcare Fraud Investigators.

The Bureau facilitates the detection of insurance fraud and works to reduce fraud occurrence through enforcement and deterrence. Additionally, the Bureau requires restitution for deceptively obtained insurance benefits, and by doing so reduces the amount of premium dollars used to pay fraudulent claims, in turn decreasing the likelihood of premium increases.

The Delaware Department of Insurance Fraud Bureau can be reached toll free at (800) 632-5154, or (302) 672-7350, or by emailing fraud@delaware.gov. Reporting known or suspected fraud is free of charge and can be done confidentially.

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Delaware Commissioner selected from leaders across the country to head important consumer-focused committee

Delaware Insurance Commissioner Trinidad Navarro was appointed Chair of the National Association of Insurance Commissioner’s Antifraud Task Force this week. Commissioner Navarro previously served as Vice-Chair of the committee, and served in law enforcement for much of his career before his election to Insurance Commissioner in 2016. The committee’s work takes on an inclusive consumer protection approach that encompasses identification and reduction of criminal efforts both by and against consumers.

“From my experience as a law enforcement officer to today, I have always prioritized the protection of our residents, and that means being proactive as well as responsive,” said Commissioner Navarro. “Fraud impacts everyone – even if you aren’t the target of a scheme. When an organization takes advantage of a consumer, it hurts the public trust as well as the customer’s wallet. When a resident commits fraud and takes money from an insurer, the companies make themselves whole by increasing costs on policyholders, even though it’s not their fault. Solutions to the problem are important, but we need to focus on stopping fraud before it starts.”

The Task Force works with insurance regulators across the country, as well as local, state, federal and international law enforcement and antifraud organizations. As Chair, Commissioner Navarro will work to provide guidance and resources for insurance departments across the country and in the U.S. Territories, including tracking and analyzing trends in fraud, one of which is the rapidly changing cybersecurity environment.

“Methods of fraud are always evolving, and with more of our personal data being shared digitally than ever, there is no more important time to place serious emphasis on fraud prevention than now,” said Commissioner Navarro. “To be successful, we have to be clear that a vital piece of protecting our policyholders lies in protecting their data.”

Data, its collection, use, and misuse, has quickly risen as a key issue within the insurance community and the public at large. In 2019, multiple data breaches at insurers impacted more than 100,000 Delaware residents. Commissioner Navarro, with the help of the General Assembly, worked to make sure that Delaware passed the Insurance Data Security Act following these breaches, one of the first states to do so.

Protecting residents and policyholders is central to the Commissioner’s administration. The Department of Insurance Fraud Bureau investigates consumer complaints and inquiries, polices the conduct of carriers, agents, and brokers doing business in Delaware, and prosecutes insurance fraud amongst other duties. From 2015 to date, the Bureau has seen an approximate 23% increase in reports. The department has brought forward 37 civil cases, 54 criminal charges, 18 criminal arrests, and more than $47,400 in civil penalties since 2018. In the same time period, 1,100 fraud tips and referrals have been provided to the office.

The Delaware Department of Insurance Fraud Division can be reached toll free at (800) 632-5154, or (302) 672-7350, or by emailing fraud@delaware.gov. Reporting known or suspected fraud is free of charge, and can be done confidentially.

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