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Have you ever been involved in an accident that you did not believe was your fault but the police told you were at fault and you were adamant that it was a fraudulent loss?  If so, when reporting this claim be sure to advise your representative because you may just be right on the money.

Mrs. Honesty was pulling up to a stop sign when she noticed two pedestrians (a male and a female) standing on the curb.  She made eye contact with both of them and motioned to them as if to ask if they were going to cross in front of her and they both shook their heads.  When she pulled forward from the stop sign the female pedestrian darted right in front of her vehicle and threw her body up onto her hood and then started screaming and insisting that she was hurt and required medical attention.  

The male pedestrian that was present was not contacted by the car and made no mention of being hit by the vehicle to the police.  Independent witnesses also confirmed that there was no contact between the vehicle and the male pedestrian.

Mrs. Honsety reported the claim and was very adamant that she did not strike these pedestrians and that this was an attempt by these pedestrians to make a fraudulent claim against the insurance company.

Soon after this, the representative handling the claim received a Letter of Representation from an attorney on the behalf of both pedestrians, claiming that both of them had been hit and both had sustained serious injuries.

The representative handling the claim was baffled as the police report and witnesses confirmed that the male pedestrian was not struck and then remembered how adamant Mrs. Honesty was that this was a fraudulent claim.  So the representative ran a full background check on both of the pedestrians and learned that the female pedestrian had quite a checkered history involving insurance fraud and had been imprisoned for several offenses.

The representative then referred the file to a special department that handles cases that don’t quite smell right that works in concert with the police and the district attorney of each district to weed out fraud.

The case is still being investigated at this time, but the lesson to be learned here is:  if it doesn’t smell right, tell your claims representative because a full investigation will be completed and your instinct should never be ignored.
Posted 2:55 PM  View Comments

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