NU Online News Service, Sept. 22, 2:26 p.m. EDT
Three top insurance crimebusters have been honored by the International Association of Special Investigation Units (IASIU) for busting up a variety of massive claim scams.
Those honored at the IASIU annual meeting at Palm Desert, Calif. were Tom Cockerill, State Farm, Investigator of the Year; Michelle Bergeron, Esurance, Analyst of the Year; Michael Vergon, U.S. Alcohol Tobacco and Firearms Bureau, Public Service Award and Mike McKee, Outstanding Service Award, National Insurance Crime Bureau.
Mr. Cockerill revealed the activities of a roofing and siding contractor who operated as a "storm chaser" — going from one disaster to another to file inflated and fake claims for hail damage, intentionally damaging roofs and teaching employees to do the same.
A state civil action and civil racketeering action resulted from his investigation ASIU said. Key to the case was Mr. Cockerill's uncovering of an e-mail message the contractor sent employees telling them to stop causing intentional damage to avoid suspicion by insurance investigators.
Ms. Bergeron was selected for Analyst of the Year for starting an SIU analyst program at Esurance. She built an analysis process from the ground up, using state-of-the-art software tools and targeted production reports to identify fraud trends and spot organized rings.
IASIU said Ms. Bergeron's efforts have resulted in eight organized fraud rings being identified in 2009, with an exposure to Esurance of approximately $2 million. One ring was identified using a red flag report designed to compare accidents that involved multiple passengers with injuries shortly after policy inception. Currently, the U.S. Postal Service is continuing the investigation because the case was too large for local fraud investigators to resolve.
Mr. McKee received his award for giving presentations that have trained more than 2,200 insurance investigators and law enforcement officers. He is also a member of three task forces where he has guided high-profile investigations involving terrorism, phantom diagnostic clinics, medical equipment scams, and bogus smoke claims arising from recent wild fires.
IASIU said one investigation saved insurers $3 million, identified more than 2,000 suspicious wild fire claims, and led to the prosecution of 25 people from an organized fraud ring.
Mr. Vergon was selected for the public service award for being instrumental in breaking up what IASIU said was "one of the largest arson rings in recent memory."
The 2006 case cracked a gang that was burning homes around Muncie, Ind. and Indianapolis, that was so skilled in their work that officials almost always ruled the blazes as accidental leading to quick claim settlements.
IASIU said Mr. Vergon's efforts turned up critical information that helped reveal a brother-sister team that purchased lowpriced houses and apartment buildings, inflated their values and over-insured them, then burned them down. Houses would be loaded with used furniture to increase personal property claims payouts and a dishonest public adjuster was used to help inflate claims further.
His three-year investigation resulted in prison terms for key players in the ring, who were ordered to pay $2.3 million in restitution.
Eric Gilkey is editor of Claims magazine, part of Summit Business Media's P&C Magazine Group, which includes National Underwriter.
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