| Fraud's a fault of no-fault
Still, it's a good living, even at the bottom of
the chain.
"The cappers are making more money than drug
dealers," says Melchionni. "It's the hot, new street profession
because there's no felony conviction involved, it's less risky and
takes less time."
At this pace, "There is little doubt that New
York state will catapult to the ignominious ranking of the most
expensive automobile insurance state in the nation," Roger
Schmelzer, vice president of regulatory affairs for the National
Association of Mutual Insurance has said. But fraud has a chokehold
on other states as well:
- When Colorado car insurance rates rose 20
percent in 2002, primarily to cover fraudulent claims, lawmakers
in the Centennial state trashed its 30-year-old no-fault system
to return to tort liability beginning in July 2003.
- More than 20 percent of auto premium dollars in
Florida currently go to pay for fraud, according to that state's
insurance department -- make that 80 percent in Miami. Drivers
there were staring at a 55 percent premium increase in 2002 to
keep pace with the crooks.
- Auto insurers, including State Farm -- the nation's
largest -- fled screaming from New Jersey to escape its fraud
claim volume. Until legislators there grabbed the bull by the
horns in 2003, it cost insurers twice as much to treat auto accidents
in the Garden State as in comparable states.
"I've read articles suggesting that insurers
roll over, paying these claims because they don't want to investigate
them. That's not true," says Kirk Hansen, director of claims
for the Alliance of American Insurers in Downers Grove, Ill. But
New York insurers, for instance, have only 30 days to challenge.
After that short window, they can't raise fraud to deny the claim.
Industry's tied hands
Should the insurer take a claimant to arbitration, even if it wins
99 percent of the issues and loses just 1 percent, the company must
pay the total bill submitted. Not to mention insurance companies
don't carry prosecutorial authority. Their staffers can't throw
folks in jail. The best they can do is spoon-feed information to
law enforcement and pray for an arrest and conviction.
"First you look at the data and think it's an
aberration," Hartwig explains. "Then you spend hundreds
of thousands of dollars investigating before you can try to do something
about it. All this takes a while, especially when you are not allowed
to do much about it."
The industry is taking steps to shed its victim status,
funding the National Insurance Crime Bureau to help law enforcement
identify, detect and prosecute insurance criminals. Technology gurus
have designed software that links each new claim to previous submissions
to detect patterns faster.
Slow progress
A bust in September 2003 that grabbed 51 suspects off New York City's
streets boosted insurance companies and consumers' hopes, as well.
Liberty Mutual, Kemper, MetLife, Allstate and Progressive insurance
companies are just a handful of the household names that cooperated
with the New York Police Department behind the scenes to shut down
what appears to be part of a national operation.
And lobbyists continue to pound on state legislators'
doors, demanding changes ranging from mandatory medical protocols
for vehicle accidents to felony status for arrested cappers. Lawmakers
such as U.S. Sen. Chuck Schumer (D-New York) have pushed, unsuccessfully,
to make auto insurance fraud a federal crime.
Ditching no-fault status altogether, however,
remains unpopular.
"It's a good idea. Without it, people have
to sue to get a legitimate injury covered," Hartwig says. "But
it's been corrupted."
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