Fraud Division Overview
Investigation Division Overview
investigation: types of violations
- Premium Theft - Identified by the Investigation Division staff as the single most prevalent type of misconduct seen in the insurer producer area. Instances can range from a single theft of minimal amounts to multi-million dollar scams perpetrated on the public and the insurance industry.
- Life & Health Senior Citizen Abuse - Particular agents and insurers concentrate their marketing efforts on senior citizens. Certain agents and insurers abuse the senior citizen customer by over selling, misrepresentation and selling unneeded or even inappropriate insurance products to them. At times the misconduct is criminal, involving theft, false documents and confidence games.
- Insurance Company Deceptive Fraudulent Acts - Insurers may fail to properly monitor and control their sales forces, in part because they are seen as independent contractors. The failure in extreme cases may involve ignoring complaints and other evidence of sales force misconduct or even training and encouraging misconduct.
- Bogus/Unauthorized Insurance Companies - A type of scheme that runs the gamut of illegally collecting premiums to selling falsified paper that appears to be an insurance policy. This includes everything from fraudulent insurance identification cards sold in DMV parking lots to fully-operational offshore insurance companies issuing policies they have no intention of honoring.
- Public Adjuster Violations - Public Adjusters represent the interest of insureds who have suffered a claims loss. In some cases, both licensed and unlicensed individuals have further harmed their clients (after the initial loss) by engaging in unlawful activities, such as a charging exorbitant fees and providing unlicensed contractors who either do faulty workmanship or exit the job leaving repairs incomplete. Some of the most egregious violations occur when Public Adjusters solicits clients during disasters, while the loss is occurring (ie: wildfires, earthquakes, etc).
- Title Company Rebate Activity - These cases involve title insurance rebating and kickbacks to those in the real estate industry which prevent the competition of purchasing title insurance coverage for home purchases and home refinances. The main violation seen in this area involves title company employees providing goods and services as an inducement to those in positions to assure to them, the placement or referral of title business.
- Bail Industry Misconduct - Bail Agents are unique in the insurance field, in their personal control of arrestees released to them, acting as "a jailor of the arrestees own choosing." They control the essential components of the insurance company claim settlement under the bail collateral system. Their conduct can easily affect an insurer's finances adversely and, of course, theft and personal integrity issues affecting a bail agent are highly serious to all concerned. The violations seen most in the bail arena are the failure to return collateral and unlicensed activity.