An agent has committed an insurance crime

Report Suspected Insurance Fraud

If you suspect that insurance fraud has been committed, you should report it to the DFS or call the Insurance Fraud Hotline: 888-FRAUDNY (888-372-8369) right away. The matter will be kept confidential.

What is Insurance Fraud?

Insurance fraud is a crime. And far from being a victimless crime, insurance fraud victimizes every resident of New York State, costing consumers millions of dollars in the form of increased premiums and higher prices for goods and services. The exact cost of insurance fraud is difficult to estimate because much of it goes unreported. The public can help reduce fraud and minimize its impact by learning how to recognize fraud, by avoiding becoming a victim of fraud, and by reporting suspected fraud to the DFS.

Insurance Fraud takes many forms

• A driver and a body shop worker agree to inflate the auto damage claim and share the "profit."
• A homeowner falsely claims that his home was burglarized and valuable items stolen.
• A doctor bills an insurer for services that were not provided.
• A driver stages a fake accident, and unscrupulous doctors and lawyers help "handle" associated medical claims and lawsuits.
• A worker collects workers' compensation benefits while employed.

As a consumer, there are several common-sense steps you can take to help reduce your risk of becoming a victim of fraud and minimize its impact.

Be an Informed Consumer

Insurance premiums are a significant expense for most of us. The premiums you pay are based on your individual claims history and the degree of risk involved. Generally, the greater the risk, the higher the premium. For example, the theft premium for a Cadillac will be far higher than that of a Toyota because more Cadillacs are stolen each year. Similarly, a stock car racer will pay more for life insurance than a librarian, all else being equal.

Know Your Agent or Broker

Consumers can sometimes be victimized by unscrupulous agents or brokers and discover only after they file a claim that they are without coverage. If an uninsured home is damaged by fire, the owner is solely responsible for restoring it and paying back any mortgage holders. If a driver is involved in an accident while driving an uninsured vehicle, any personal assets are subject to forfeiture if that driver is sued for damages. Deal only with licensed agents and brokers. They must maintain proof of being licensed. Ask to see it.

Get a Copy of Your Policy

You should receive a copy of any type of insurance policy complete with endorsements and declarations specifically outlining your coverage and its limitations within a reasonable period after your purchase. If you do not receive it, question your insurer, agent or broker. If there is no satisfactory explanation for the delay, contact the Department of Financial Services at (800) 342-3736. You may not have the insurance coverage you paid for.

Pay Only for Services You Have Received

If you have received medical or dental treatment that is covered by a health care provider, you will receive an "Explanation of Benefits" statement listing the services for which benefits have been paid. Review it thoroughly to ensure that you have not been billed for services that were not rendered or for dates on which you were not treated. Check carefully to confirm that you were not billed for more expensive procedures than were actually provided, a practice known as upcoding.  Contact your insurer immediately if you feel there are discrepancies.

Health care fraud translates into billions of dollars a year, resulting in higher premiums and increased costs for goods and services for all consumers. If you suspect fraud, contact the Department of Financial Services at (800) 342-3736. An investigator will contact you for details and the matter will be kept confidential.

What If You're Involved in an Automobile Accident?

Report the incident to the police and obtain a copy of the Police Accident Report. Be suspicious if the driver of the other vehicle insists it is not necessary to contact the police. That driver’s car may be uninsured or his/her insurance identification card may be fraudulent. Be sure to make note of the other vehicle’s license plate number and obtain important insurance information. If possible, take a photo of the damages.

Common Scams

Watch out for these common insurance scams:

The staged accident

A vehicle filled with people will stop suddenly in front of you, setting you up as the cause of a rear-end collision, while doctors and lawyers who are participants in the scheme “handle” the subsequent medical claims and lawsuits.

Runners

These individuals will solicit the injured or allegedly injured parties at the accident scene or shortly thereafter and direct them to medical facilities that are involved in the scam. If you are involved in an accident, be on the lookout for “runners” and don’t become a victim. In addition, be suspicious if, following an emergency room visit, you are contacted by someone claiming to be employed at the hospital who recommends a particular medical facility for follow-up treatment. Also be wary if a lawyer who is unknown to you recommends a specific law firm to discuss a possible lawsuit.

Inflated claims

At the accident scene, be sure you know the extent of the damages to your car and the other vehicle. Carefully review subsequent repair estimates and claims. Body shops may enhance existing damages or conspire with adjusters to inflate the repair estimate. Don't allow high-pressure salesmanship to persuade you to sign up for a type of policy or certain coverage that you are not sure you need. Take time to decide what's right for you. Read your policy carefully before you sign. If you have questions, ask your agent or broker, or your insurer.

Fraud vs. Consumer Complaints

Please do not confuse the crime of insurance fraud with a dispute that you may have with an insurance company, for example, delays in customer payment, monetary disputes, policy cancellations and nonrenewals.

Do not confuse the crime of fraud with a dispute that you may have with an institution or complaint you may want to file for example: complaints about delays in mortgage loan modifications, delayed customer payment, monetary disputes, policy cancellations and non-renewals. If you have a complaint or an inquiry not involving fraud please File a Complaint.