COLLISION INDUSTRY CONFERENCE

GUIDE TO FRAUD AWARENESS

(Revised November, 1997)



PLEASE BE ADVISED!


THIS BOOKLET IS NOT MEANT TO PROVIDE LEGAL GUIDELINES. ITS ONLY PURPOSE IS TO BRING AN AWARENESS TO THE PROBLEM OF FRAUD AND FRAUDULENT BEHAVIOR IN THE REPAIR - INSURANCE - APPRAISAL INDUSTRY.


Collision Industry Conference

This booklet was produced by the Anti-Fraud Committee of the Collision Industry Conference (CIC). CIC is not an association, but is a gathering of representatives of the various industries involved in the auto physical damage claims process -- insurers, repairers, appraisers, automobile and parts manufacturers, estimating technology providers and other suppliers. They meet four times a year to discuss concerns over issues affecting their mutual industries, and to work together to develop understanding and possible solutions. For more information, call 509-547-3810.

Copyright 1997. Collision Industry Conference (CIC)
Permission to reprint this document in its entirety is granted as long as no changes are made.


DEFINITIONS FOR FRAUD


FRAUD

An intentional misrepresentation of a past or present fact made to cause someone to rely on it to give up some legal right or thing of value. The misrepresentation of a fact can be made by words, including innuendo, by conduct, or by concealing a fact that the person has a duty to disclose. The conduct can occur through looks or gestures. It can occur as a single act or statement or as a combination of circumstances. It includes surprise, trickery, cunning, design, deception, or any unfair way by which another is cheated.

COLLUSION

Occurs when two or more people agree to defraud or cheat someone or agree to accomplish an illegal purpose. It is accomplished through fraud, either by using fraudulent methods, such as trickery or deception, or by using lawful methods to accomplish an unlawful goal.

COMMERCIAL BRIBERY

A corrupt and unfair trade practice in which a competitor pays or induces another's employee to betray his employer, to act against his employer's best interests, or to compete unfairly with his employer's competitor.

BREACH OF CONTRACT

Occurs when a party to a contract fails or absolutely refuses to perform the promise he made in the agreement. It also occurs when a party to a contract prevents or hinders the other party from performing his agreement.

OSTENSIBLE AUTHORITY

The implied authority of power for a person (the agent) to act on behalf of another (the principal). It arises when the principal intentionally or carelessly causes or lets someone believe the agent may act for him, even though the principal never actually gave the agent that power and there is no real agency. Some courts also call it "apparent authority".

The above definitions can be found in Black's Law Dictionary (6th ed 1990).

COLLISION INDUSTRY
DEFINITIONS FOR FRAUD


BURYING THE DEDUCTIBLE

This occurs when an estimator or repairer takes the amount of the policyholder's deductible and "hides" these costs elsewhere in the estimate through the methods described as "cost shifting". This is done at the policyholder's request in order to avoid paying the deductible, or is offered by a repairer as an inducement to keep the repair work at that particular shop. In many states this is considered an illegal practice. This does not pertain to those occasions where a repairer may offer to accept less of a profit on a job, but still perform the repair and use the parts precisely as agreed to in the repair estimate.

COST SHIFTING

Occurs during the process of writing an auto physical damage appraisal or a final bill for repairs when all or some of the cost of one line item is transferred to another. This may involve adding unnecessary procedures by exaggerating labor times/costs in one area of repair to offset costs not included elsewhere in the damage appraisal or final bill. It may also involve using a less expensive part than one listed on the appraisal or final bill (or repairing a part that is listed as replaced) in order to cover labor times/costs or parts not included elsewhere in the appraisal or final bill.


FRAUD

For years, insurance settlements have meant lucrative deals to many Americans. Everyone knows someone who was injured, or unfairly taken advantage of, and who has received a settlement for a large sum of money. Most of the people were deserving. Some were not. What might seem like a fair or deserved settlement to some people may actually involve a form of fraud. Most people are honest and ethical in their negotiations, but some utilize business practices that are unethical and are likely to be illegal.

The cost of all insurance fraud is reported to be in the billions of dollars. Auto physical damage claims are only part of this. However, everyone pays the tab. From the vehicle owner who tries to get the insurance company to pay for old damage, to the consortium of thieves who stage accidents, people have been trying to squeeze the maximum dollars out of an accident for years. The bottom line here is this: insurance fraud costs each and everyone of us. We all pay for insurance fraud when we pay our insurance premiums.

WHAT HAS HAPPENED AND WHY?

In days past, an estimate was just that -- an educated guess of what someone thought it would take to repair a car. Estimate or guesstimate, there wasn't much difference. But today things are different. Customers are different, their expectations are different, their cars are different, the technology to accurately assess the damage is different, and the legal system is different. Even a seemingly small claim can cost a lot of money.

As we'll find later in this booklet, it's not only what we do, but what we write, what we say, and how we say it that matters. It's a changing world and if we look toward the future, we'll be able to change with it. Hopefully, this booklet will give you some information on how to avoid the problem of fraud.

JUST AN ACCIDENT OR A CHANCE FOR FRAUD?

It was just a small auto accident. A fender bender. A wrong turn at an inappropriate time. The damage wasn't too severe, but "not too severe" can mean thousands of dollars. The injuries were minor, tempers flared, emotions were high. Maybe there was a little discomfort, a few sore spots. But all in all, it wasn't as bad as it could have been. Or is it?

From an owner's viewpoint:
It's damage to my pride and joy. I still have 38 payments to go. I'm frustrated at the very least. It's going to take some time going to the insurance company and going to the shop. It's just one more aggravation in my already hectic world. But isn't that how the neighbor got the new paint job on his car, and the guy at work found the money to take a vacation. And didn't my brother-in-law not have to pay his deductible that time when he backed out and hit my mailbox? That deductible was $250.00. Surely I can get something out of this. And didn't old Fred Sanford say, "Ah-h-h whiplash--it rhymes with get cash"?

From a repair facility's viewpoint: Here comes another customer and the profit on this job may help us buy that new piece of equipment the technicians say we need. It's a good job, something else to keep the guys in the back busy. After all, there just doesn't seem like there are as many wrecks as there used to be. I have to make it up on this one. If we get lucky and everything goes right, I may even be able to pay my suppliers this month. It may even be one of those jobs that I can bill for a lot of parts, but straighten and replace the old ones. Those phantom parts jobs are really profitable. I may even be able to make some money back on that last job.

From an appraiser's viewpoint:
Here's another assignment. With the way things are, I need to get this one turned around in a hurry. If I can turn it quickly, maybe the fee will cover the time I spend. Demands on us are increasing from all sides. I've got to make the insurer happy, the car owner happy, and at the same time, not upset the shop. Maybe I can put a feather in my cap by getting by without paying for some of those little items. If the shop says anything, I'll just hide it somewhere else in the repair. With a little creative writing, I can make everyone happy. Maybe the shop will already have the estimate written and all I'll have to do is copy it. No one will know the difference. This could turn into a big day if I get several of these. Maybe I can even get the shop to fix my headlight if I don't hassle him too much and put a little extra on the estimate.

From an insurance company's viewpoint:
It's a loss, but if we manage the claim correctly, we'll be able to control the cost and keep our customers satisfied. The claims staff and the independent appraisers we hire are good. I know they'll protect us. The insurance department regulators are coming down on us because they think our rates are too high. We must keep our rates low. Claims cost our company money.

While not all individuals attempt a fraudulent act, a growing number of individuals view it as the American way. People have been trying to squeeze the maximum dollars out of an insurance settlement for years--sometimes in legal ways and sometimes by using more creative methods than the law allows. But in reality, even small amounts of insurance fraud can add up to billions of dollars. Everyone who purchases insurance pays the tab.


Additional Notes and Thoughts:


Just as any construction project starts with a blueprint, the restoration of a collision-damaged car starts with a damage report. This is the blueprint for the repair process. Just as the blueprint of a construction project details the materials to be used, the techniques to be used and the appearance of the completed project, today's damage report should likewise reflect the work to be performed.

Five Reasons People Consider Committing Fraud:

Poor Service. A customer wasn't treated fairly or received poor service from the shop or the insurance company. They want to get back at someone because of it, to make it worth their while.

Poor Quality. The owner's car was not repaired properly or to their satisfaction the last time. The diminished value, the aggravation, the time lost makes them want to "get back" at someone.

Lack of education on the issue of fraud by the consumer. Everybody does it, they've heard. Saving deductibles is a common practice.

Lack of education and focus on the issue of fraud by the repair, insurance, and appraiser industries. Everyone thinks someone else does it. The first thing that they think of when a competing repair shop is busy is that the shop must be paying someone off or burying deductibles or maybe even both. They're afraid if they won't do it, someone else will.

Entitlement. People think that they deserve more than they are getting because they have paid all those premiums over the years and never used the insurance. They view insurance as an investment, not protection over a period of time, from a larger catastrophe. They see the bottom line and do not realize a repair facility does not make 100% profit.


FACTS ON
"BURYING THE DEDUCTIBLES"


From time to time, repairers are all faced with requests from car owners to "bury the deductible" where automobile damage is covered by collision insurance.

Before the vehicle owner takes the collision-damaged car around the corner to someone who will bury the deductible, the car owner should consider the following points:

1.Conspiring to "bury the deductible" is committing a fraud upon an insurance company and is against the law in most areas.

2.Insurance company appraisers know the cost of repairs, as well as body shops, and cannot be fooled by inflated estimates.

3.If a shop agrees to "bury the deductible", it might take short cuts in making the repairs, and the owner could get a second-rate job, which depreciates the value of the car at trade-in time.

4.A body shop willing to cheat an insurance company will be equally willing to cheat the car owner. A body shop rarely absorbs the deductible. The value is taken right out of the job, and it is the car owner who still takes the loss.

5.If the body shop decides to cut corners on the job and it ends up second rate, the owner has no one to complain to if he conspired to "bury the deductible".

6.The repairer, insurer, and vehicle owner all have an obligation to return insured vehicles back to a pre-accident condition as detailed in the estimate and final invoice.

The correct thing for owners to do is protect their investment by getting a first-class job from a first-class shop, and be glad that all they have to pay is the deductible.

IT IS THE ONLY WAY THEY CAN WIN.



DO'S & DON'TS CONCERNING FRAUD


DO

* Write as complete and accurate a damage report as possible.
* Be knowledgeable in the repair process.
* Make only factual statements.
* Be absolutely sure you have the authority, before making agreements.
* Document all actions.
* Be sure everyone involved is aware of exactly what is to transpire in the repair process (customer, appraiser, repairer, insurance company).
* Invoice for exactly what is repaired and how it is repaired.
* Clearly spell out what is expected from all parties. Write instructions or conditions and put in file when practical.
* Approach all endeavors with the highest degree of professionalism.
* Respect opposing points of view, but be steadfast in your own if other positions conflict with what is right.
* Understand that things change and that when they do, new agreements must be made ... but all must be aware of and in agreement with any alterations to an original agreement.
* Write only what is needed and necessary to complete repairs.
* Follow manufacturer and industry established procedures for repairs.
* Document, document, document ... Verify, verify, verify.
* USE COMMON SENSE!
* Advise customers when they ask you to take an action that might be perceived as fraud, that might be considered fraud, or at the very least poor business. Your business cannot afford to be involved.

DON'T

*Lie!
*Write something you know won't be done to cover something else.
*Overwrite repair allowances.
*Write unneeded repairs (i.e., R/I and/or R/R, when they are not needed).
*Ask for special deals on personal work.
*Write unneeded parts.
*Make misleading statements concerning any repairs.
*Accept gratuities of any type (there is no free lunch).
*Agree to something while knowing it is in direct conflict with company policy.
*Cover up for vehicle owner (i.e., fail to disclose prior damage or pertinent facts when they are known).



SIDE BAR THOUGHT - It is possible to eliminate fraud and and practices which might be perceived as fraud. What you do and say will have an impact on this.


CONTACT NUMBERS TO REPORT FRAUD

GENERAL INFORMATION 1-800-TEL-NICB
ALPHA PROPERTY & CASUALTY INS. CO. 1-800-826-0233 ext.7150
ERIE INSURANCE EXCHANGE 1-800-368-6696
FARM BUREAU INS. CO. OF NE 1-800-742-4016
FARMLAND MUTUAL INS. CO. 1-800-474-7633
(NATIONWIDE INS. ENT.)
FEDERATED MUTUAL INSURANCE CO. 1-913-451-1962
GENERAL ACCIDENT INS. CO. 1-800-365-4885
HIGHLANDS INSURANCE CO. 1-713-267-8347
HORACE MANN INSURANCE CO. 1-800-TEL-NICB
KEMPER NATIONAL INS. COMPANIES 1-800-833-0355
LIBERTY MUTUAL INSURANCE GROUP 1-800-932-3972
MINNESOTA FIRE & CASUALTY CO. 1-612-939-7028
NATIONAL INSURANCE CRIME BUREAU 1-800-835-6422
OHIO CASUALTY INSURANCE GROUP 1-800-843-6446 ext.3294
PEMCO 1-206-628-7959
RELIANCE INSURANCE COMPANY 1-800-743-7404
RISK ENTERPRISE MANAGEMENT LTD 1-800-366-5576
ROYAL/INVESTIGATIVE RES. GLOBAL INS. 1-800-694-2312
STATE FARM 1-800-835-6422
UNION INSURANCE COMPANY 1-800-456-7688
USAA INSURANCE 1-800-531-8888
WAUSAU INSURANCE COMPANIES 1-800-238-0444
WESTFIELD COMPANIES 1-800-654-6482

CIC ANTI-FRAUD COMMITTEE 1-816-254-1764