Three Residents Indicted for Insurance Fraud by Grand Jury

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.


Woman indicted for $16,000 of fraudulent insurance claims

Dover, DE   August 8, 2019 — A Wilmington woman was indicted by the New Castle County Grand Jury for insurance fraud and other felony charges. Theresa T. Milton, 44, of the 900 block of Clayton Street, was indicted on seven felony counts of insurance fraud, one felony count of theft by false pretense, and one count of falsifying business records. An Investigation by the Delaware Department of Insurance Fraud Prevention Bureau revealed that beginning on the 4th day of May, 2017, and continuing through on or about the 28th day of September, 2017, Theresa Milton submitted false claims for emergency medical services to Highmark BCBS of Delaware totaling slightly more than $16,000.  She had falsified invoices for out of network ambulance services and submitted claims for payment for those services to Highmark BCBS of Delaware.

Highmark became suspicious of one of the claims and made an inquiry to the ambulance service.  It was discovered that the claims appeared to be false, and the case was referred to the Department of Insurance Fraud Prevention Bureau for investigation.  The investigation substantiated the false claims with fictitious business records, and the indictment was issued.

Commissioner Trinidad Navarro stated, “The Fraud Unit of the Delaware Department of Insurance takes these cases seriously and actively investigates all reported cases of insurance fraud. We work closely with our partners at the Delaware Department of Justice to see these cases through, protecting consumers. A case such as this brings to light that insurance fraud costs everyone.”

If you suspect insurance fraud, you can report it by calling 302-674-7350, or email to fraud@delaware.gov.

 

The Delaware Department of Insurance protects Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.

Contact: Vince Ryan
Office: (302) 674-7303
Mobile: (302) 387-7670
Email: vince.ryan@sdelaware.gov