The following case studies reflect just a small percentage of results obtained by LMAR investigators.
1. A 37 year old insured reported his Audi Q7 as stolen from a northern Alberta City in mid-February from a friend’s residence where he claimed he had spent the night. The LMAR investigation empirically determined that the vehicle had last been driven one month prior to the reported theft and was not in the City at the time it was reported stolen. LMAR obtained video and documentary evidence that placed the insured at a hotel at the time of the theft operating a half ton truck, not the Audi. Based on our investigation the insured withdrew his claim. A previous claim for collision damage was also denied. Total savings to insurer pegged at $102,000.
2. A 42 year old insured reported a half ton truck stolen from a rural northern community. The vehicle was recovered burned 24 hours later by police. LMAR obtained statements from acquaintances of the insured which determined that she was heavily involved in the illicit drug trade and was in debt to a number of street dealers. The insured came up with the idea to claim the vehicle stolen as a means to collect an insurance payout. From the totality of the evidence uncovered by LMAR the insurer was able to deny the claim. Savings of $16,000.
3. During a civil case stemming from a TP bodily injury claim an Insurer’s lawyer requested we review the matter. This review was requested almost 5 years after the event. The facts alleged were that vehicle A was struck from behind by vehicle B. Vehicle A left the scene prior to the arrival of police. The driver of vehicle B remained at the scene and was charged by police. The owner of vehicle A attended the police station with his cousin and reported the collision. Both A and B were insured by the same underwriter. The driver of vehicle A was reported to police as a cousin to the owner of the vehicle. The owner claimed his cousin was driving alone in vehicle A when the collision took place. Fault was attributed to the driver of vehicle B. The driver of vehicle A put forward a BI claim for injuries arising from the collision. Through the driver of vehicle B, LMAR uncovered that he was friends with the owner of vehicle A and had been following him at the time of the collision to a local drinking establishment. During the initial LMAR interview with the owner of vehicle A the details provided and language used was found to be consistent with the recall of a driver rather than a person hearing the details second hand. Based on these findings a follow up interview with the owner of vehicle A was conducted by LMAR during which he admitted he was the driver at the time of the collision but because he was suspended from driving at the time he fled the scene and then requested his cousin claim to be the driver. The cousin, unbeknownst to the insured, put forward a BI claim even though he was not involved in the collision. LMAR’s ability to obtain these details years after the event supported this was a fraudulent BI claim. Savings in excess of $50,000.
4. A couple were driving home from socializing in the insured’s vehicle. It was after 2 AM. The vehicle lost control and struck a pole. The insured owner of the vehicle allegedly left the scene on foot. Police arrived on scene within minutes and arrested the male for impaired driving. At trial the male was acquitted. Based on the acquittal the insured put forward a claim for the loss of the vehicle and medical costs for both herself and her male friend. Section B costs were claimed. Statements had been obtained from both parties at the time of the event by an adjustor. Subsequent statements were also taken after the acquittal by an adjustor. Concerns regarding the truthfulness of the statements were raised and the matter was assigned to LMAR for review. Copies of the Court transcripts were reviewed as well as the statements provided to the adjustors on the two occasions. During an LMAR interview the male passenger admitted that he had been the driver; subsequently the female insured also admitted to LMAR that her previous statements had not been truthful. Based on the quality of the LMAR statements the Insurer’s lawyers recommended a denial of the claim. No further efforts were made by the insured on her claim. Savings in excess of $20,000
5. An individual put forward a claim for the loss of personal property in excess of $21,000 while vacationing in the United States (vehicle break in). The claim had been settled. The insured then attempted to claim that he had a subsequent loss claim involving an Insurer’s supplier of a replacement article. Given the size of the loss LMAR was requested to review the initial and subsequent claim. The LMAR investigator, based on his experience, quickly realized that the details as provided by the insured related to the theft were unlikely to have occurred as claimed in the police report. Further investigation revealed a history of similar claims by the insured during other ‘vacation thefts’. LMAR determined that the insured had used numerous variations of his hyphenated name to open multiple property policies through which multiple claims had been paid out. When LMAR met with the insured and laid out the evidence they had amassed the insured stopped denying fraudulent behavior and began bargaining to pay back the $21,000 to make the matter go away. Details of the LMAR investigation were forwarded to the Insurance Bureau of Canada to put out an advisory for other Underwriters to be aware of the history of fraudulent claims by the insured. Though another Insurer had their SIU looking into a similar claim from this individual it was only the LMAR investigation that led to a successful conclusion.
6. A business owner put forward a claim for the loss of $124,000 worth of equipment stemming from a reported theft of a C-can from a job site. LMAR was requested to review the details as due diligence based on the size of the claim – the adjustor was not suspicious of the claim. LMAR attended the job site to obtain photographs. During their time on the job site and from casual interviews with company employees the LMAR investigator determined the claim was fraudulent. The owner was challenged on his version of events during this initial scene review and quickly withdrew the claim. Follow up investigation determined the insured had successfully scammed a previous insurer out of $96,000 for a similar claim and had another similar claim for $103,000 in the works. This matter was reported to the local police who charged the insured with fraud. The LMAR call to the adjustor advising the claim withdrawal was made within two hours of the file being assigned. Savings of $124,000.