CHICAGO--(BUSINESS WIRE)--
Economic downturns often provide a ripe environment for some consumers
and businesses to consider insurance schemes involving fraudulent
claims. Ultimately, the billions of dollars that insurers pay to
investigate and uncover fraudulent claims also result in higher
insurance premiums for policyholders. Commercial insurer CNA’s Special
Investigations Unit and Claim teams work diligently to identify and
fight fraud; and, recently, experienced a big win, resulting in savings
of more than $100,000.
In 2008, an initial claim for approximately $60,000 was filed for
damages to a marine vessel after it sustained damage due to fire. A
local marine surveyor was hired to assess the damage and monitor the
repairs, and CNA made an advance payment of $50,000. The insured then
attempted to bribe the surveyor into inflating the claim by offering him
$1,000 in cash; however, the bribe was rejected and another surveyor was
hired.
Further investigation revealed that the provided claim documentation had
been altered and actually represented vessel parts ordered prior to the
date of loss. Based on the bribe, lack of cooperation in the
investigation and the alteration of documents, CNA sued the insured for
breach of the duty of good faith and fair dealing, and fraud. In
response, the insured counterclaimed for breach of contract and bad
faith, seeking to recover the “unpaid” portion of the claim.
On the eve of the trial, the insured - faced with mounting evidence -
conceded that submitted documents had been altered, and made no
objection to the court’s ensuing judgment that, based on the insured’s
conduct, insurance coverage for the claim was invalid. CNA was awarded
the return of its $50,000 advance payment as damages, together with an
additional $10,000 award of attorneys’ fees. The counterclaim was
dismissed with prejudice.
“The take away here is that – despite receiving threats and intimidation
from sources friendly to the insured in a remote jurisdiction – a
methodical, detailed investigative approach and some tenacious advocacy
by our legal counsel won the day,” said Tim Wolfe, director of CNA’s
Special Investigations Unit.
To learn more about CNA’s SIU and their efforts to fight fraud, please
contact Tim Wolfe at Timothy.Wolfe@cna.com.
Serving businesses and professionals since 1897, CNA is the country’s
seventh largest commercial insurance writer and the 13th
largest property and casualty company. CNA’s insurance products include
standard commercial lines, specialty lines, surety, marine and other
property and casualty coverages. CNA's services include risk management,
information services, underwriting, risk control and claims
administration. For more information, please visit CNA at www.cna.com.
CNA is a registered trade mark of CNA Financial Corporation.
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CNA
Katrina Parker, 312-822-5167
Source: CNA