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David Morse & Associates Fights Insurance Fraud
"Peruse the newspaper headlines in virtually any city in the U.S., and you'll undoubtedly run across a story about insurance fraud," says Tom Reitze, President of David Morse & Associates (www.davidmorse.com), providers of third-party administrator services, field adjusting services, specialty claims services, and fraud investigations. "Most consumers don't realize that 25 percent of their insurance premiums are ultimately used to pay fraudulent claims."
Indeed, in San Jose, Calif., 25 people in an auto fraud ring were recently indicted for allegedly staging and reporting two dozen fake car accidents during a five-year period, bilking insurance companies out of an estimated $400,000. David Morse & Associates and other companies provided critical information that led to the arrests and indictments. In Bridgeport, Conn., a woman was recently convicted of torching her home in order to collect from her homeowner's insurance policy. And, in Sutton, Mass., a man pleaded guilty to worker's compensation fraud for collecting $70,000 in disability benefits while secretly working in a physically demanding job.
According to Reitze, David Morse & Associates is committed to combating insurance fraud, which ultimately helps consumers by keeping insurance premiums in check. "The premise of insurance is pooled risk, but when the bad guys bilk insurance companies, honest people suffer through higher premiums," he says. "That's why our fraud investigation unit prides itself in catching fraudsters in the act."
Reitze readily recalls any number of claims where David Morse & Associates fraud investigators and adjustors employed dogged legwork, quick thinking, and expertise to keep their clients from being defrauded and help honest consumers in the process.
In one instance, a David Morse & Associates investigator was assigned to a person alleging total disability who happened to live in a rural farming community. The investigator was inventive in locating the residence of the man, but when he was not at home, the investigator had to turn to townspeople for help. The investigator was told that the "disabled" claimant was building a house in a nearby town. Reitze points out with pride, "Although the investigator was required to videotape the man, he found himself in the midst of fields, with no place to hide his vehicle. Using his imagination, he staged a vehicle breakdown on the side of the highway, and managed to capture video of the man bouncing around over rough ground on a tractor and manhandling bales of hay. Thanks to the inventiveness of the investigator, the videotape was enough to end the disability claim of the farmer."
In another situation, a David Morse & Associates truck adjustor found himself at odds with the California Highway Patrol. After a tractor-trailer collided with a van and overturned on a Los Angeles freeway, the CHP made a determination that the rig had been speeding. Although the adjustor knew that the truck had an engine governor that prevented it from speeding, the CHP wouldn't budge, exposing the trucking company to a million-dollar liability suit. The relentless adjustor duplicated the conditions with a replica truck and load, and had a CHP expert ride along, which convinced the CHP that the truck wasn't speeding. Following his suspicion the van was actually backing up on the freeway when it was hit, the adjustor consulted with David Morse & Associates' reconstruction engineer. His theory was confirmed when the lab discovered the telltale signs of stretched filaments in the van's taillights, indicating that the van had been in reverse and the backup lights were on at the time of impact. Because of the adjustor's diligence, the million-dollar claim was arbitrated for a relatively small amount.
Notes Reitze, "The adjustors at David Morse & Associates know that doing the right thing also means stepping in and helping people who are legitimately injured." When they do so, it often helps both the injured person and David Morse & Associates' insurance client.
As an example, a truck driver was making a turn and didn't see a pedestrian in the crosswalk. The truck screeched to a halt, but the man was knocked backwards and struck his head on the pavement. The David Morse & Associates adjustor arrived on the scene quickly, only to find passersby surrounding the man trying to get him an attorney. Although the man refused ambulance services, the adjustor could see that he was shaken and concerned. The adjustor quickly came up with a solution and drove the pedestrian to the Emergency Room himself. Moreover, the adjustor arranged for the client's Safety Director to pay for the $2,000 medical bill. The pedestrian was given a clean bill of health and was pleased with the outcome and attention he received.
The corporate culture at David Morse & Associates can be summed up by the maxim, "doing well by doing good." With 42 branches in 16 states, the company values the expeditious and personalized service they provide to their clients. "In the process, we do our part to help fight insurance fraud, which benefits both insurance companies and consumers," concludes Reitze.
About the Author
VP - Client Services - ITMG
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