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How Roofing Companies Can Fight Insurer, Adjuster, Engineer Fraud

Garofalo Carting Owners to be Sentenced in Fraud Case
The American Policyholder Association's sole purpose is to defend consumers by investigating and eliminating carrier-side fraud.

Insurers—and the adjusters and engineers they hire—commit fraud too. 

Meanwhile, your family, neighbors, and customers are being bombarded by signs and billboards warning "Watch Out for Crooked Contractors." 

The insurance industry has controlled the narrative about who commits fraud for far too long. 

While the prosecution community’s heads are turned to focus on you, carrier-side fraudsters go completely unchecked in cheating the American consumer out of an honest insurance claim. 

So let’s say it again: Insurance companies, as well as the adjusters and engineers they hire, commit fraud too.

Unfortunately, nobody is doing anything about it. 

An overwhelming majority of insurance fraud prosecution is done IN DEFENSE of insurers. 

Why? 

Because most prosecutors do not seek out fraud. 

Cases are handed to them by the insurers themselves. 

Every insurance company maintains a special investigation unit, which has inside access to confidential claims information and routinely investigates fraud claims.

They package the cases up for delivery to prosecutors.

Do insurance companies ever turn themselves in for committing fraud? It doesn’t appear so.

Furthermore, insurers often fund public prosecutors through grants and premium taxes.

This facilitates an extremely cozy relationship between insurers and the public prosecutors who rely on those funds for budgets, salaries, etc. 

Truthfully it is we, the policyholders, who provide this funding through our premiums.

Shouldn’t we be equally protected from fraud?

Adding insult to injury, if you as a private citizen report an insurer for suspected fraud and are mistaken, you could be sued.

However, insurers often have statutory immunity from such consequences if they make the same mistake and ruin an innocent party’s career and reputation.

Insurers are legally immune.

A cozy relationship between carriers and prosecutors and dramatically one-sided privileges afforded to insurers, explains why consumers are not fairly represented in an insurance fraud prosecution.

A quick Google image search of “insurance fraud arrest” will show picture after picture of contractors, consumers, and even criminals under arrest, but almost nobody from the carrier side. . . unless they’re caught stealing from the insurance company themselves.

Some of those people deserve to be in jail, but then again, so do the fraudsters that cheat a policyholder on a claim.

However, as we stated before, nobody has been looking at the insurance side.

Until now. . .

Now, for the first time in history, there is an organization whose sole purpose is to defend consumers by investigating and eliminating carrier-side fraud.

The organization is called the American Policyholder Association and we need your help!

The APA is a “non-profit 501(c)(4) watchdog organization that promotes integrity, honesty, and best practices in the property loss adjustment sector of the insurance industry."

More to the point—The APA gathers complaints of criminal fraud committed against consumers submitted by our members and, where appropriate, refers cases to prosecutors for further investigation and action.

The APA does this utilizing a very powerful tool: The APA Special Investigation Unit (SIU).

This is a unique SIU built solely for the protection of policyholders from insurer fraud.

What is insurer fraud?

While each state penal code may define this financial crime in its way, we think that the National Association of Insurance Commissioners (NAIC) Center for Policy & Research has one of the best all-around descriptions: “Insurance fraud occurs when an insurance company, agent, adjuster or consumer commits a deliberate deception in order to obtain an illegitimate gain. It can occur during the process of buying, using, selling, or underwriting of insurance.”

Another way to characterize fraud would be an intentional deception for a profit or to avoid a loss.

In addition, the APA, in partnership with its members, fields complaints against licensed professionals and refers them to state license bureaus for disciplinary action.

A common example of this would be insurer-hired engineers who allow bias toward the hiring insurer to steer them toward ethics violations.

We have observed a trend of engineers being hired more often on claims and earlier in the process, with what appears to be a strategy of denial.

Have you ever seen an insurer hire an engineer to get the policyholder more money for their claim?

While most engineers are honest professionals, we regularly receive reports of carrier-hired engineers who are not.

It is our goal to ensure that bad actors face disciplinary boards made up of honest engineers who are committed to protecting the integrity of their profession.

What can YOU do if you spot carrier-side fraud or licensee ethics violations?

While uneducated homeowners can easily fall into the trap of believing the advertising claims that insurers always have their best interest at heart, it is the highly trained restoration professional in the field every day who knows better.

If you suspect fraud, the APA has developed a user-friendly system for our members to report it to our SIU for investigation.

The APA’s website also links to all state-specific engineering lists of licensed engineers in the state and a list of licensed engineers who have been cited for disciplinary action.

Additionally, a soon-to-be-released diagnostic tool on the APA’s website will be able to equip policyholders and restoration professionals with a program to analyze engineering reports for instances of potential dishonesty or fraud & then submit them for investigation.   

For the first time, there are tools to equip roofing contractors and your customer, the American consumer, with free resources to help investigate and report potential fraud.  

How can you help?

Join the APA and be part of the mission to defend your customers, your families, and yourself from the fraudsters who value ill-gotten gains over the financial well-being of ordinary Americans who have suffered a loss and just want to be paid a fair insurance claim.  

You’ve seen the problem, now come be part of the solution. 

 

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