Insurance Fraud & Scams

 

$80 Billion in Fraudulent Claims Payments Are Made Annually

Don’t Be a Victim: Beware of Insurance Fraud and Scams

Cunning fraudsters have perfected their skill and work daily to take advantage of well-intended insurance consumers who want to protect their assets. All consumers are impacted by insurance fraud and scams, even if not directly targeted. The Coalition Against Insurance Fraud estimates that at least $80 billion in fraudulent claims payments are made annually. Who ultimately pays for insurance fraud? All of us!

As a result of insurance fraud:

  • insurance companies may increase premiums to offset the loss
  • the cost of goods and services may increase
  • the insured property may be unnecessarily damaged or not repaired properly

Protect yourself from these insurance fraud schemes and scams below. 

General Insurance Scams
  • Misrepresentation of Insurance by Agent
  • Policy Cancellation
  • Unlicensed Agent
Automobile Insurance Scams
  • Repair
  • Staged Auto Accidents
Health Insurance Scams
  • Fraudulent Medical Charges
  • Medical ID Theft
Homeowners Insurance Scams
  • Offers to Sell or Increase Coverage During a Disaster
  • Unlicensed Contractor

 


For information on COVID-19 fraud and scams, including the Federal Trade Commission's daily updated COVID-19 and Stimulus Fraud data, please visit our COVID-19 Fraud and Scams page.

 

General Insurance Scams Shield

GENERAL INSURANCE SCAMS

 

Misrepresentation of Insurance by Agent 

Misrepresentation of Insurance by Agent

Misrepresentation occurs in many forms but the most common is misleading you to believe more coverage is available or the coverage period is longer. It occurs often with short-term or limited benefit health insurance plans. Misrepresentation also occurs when non-insurance products are presented as insurance, such as discount medical plans.

Consumer Tips:

  • Only purchase and make changes to your insurance policy through a licensed insurance agent or your insurance company directly. Verify identity before making any payments or providing personal information. 
  • Review and ensure you understand any documents or contracts before signing.
  • Be sure that your insurance company or agent is licensed to do business in Florida.

To Verify an Insurance Company License:

Office of Insurance Regulation
Active Company Search
www.FLOIR.com/CompanySearch


To Verify an Insurance Agent License:

Florida Department of Financial Services
Division of Insurance Agent and Agency Services
www.MyFloridaCFO.com/Division/Agents
850.413.3137

    Policy Cancellation

    Policy Cancellation Scam Example- Worried lady on phone

    A person(s) contacts you and pretends to be an insurance agent or representative from the insurance company and threatens to cancel your coverage if specific personal information or actions are not taken. 

    Consumer Tips:

    • Purchase and make changes to your insurance policy through a licensed insurance agent or your insurance company directly. If you feel your coverage has been or will be canceled, contact your insurance agent or insurance company immediately. Verify identity before making any payments or providing personal information. 
    • Be leery of unsolicited calls. Companies should not call you unsolicited requesting personal information or ask you to verify details of your insurance coverage.
    • Do not trust the caller ID. While the name and number may appear to be that of an insurance company, it may be a scam artist attempting to obtain your personal insurance information.

    Unlicensed Agent

    Unlicensed Agent Scam - Laptop with DFS Licensee Search Screen

    An agent who is not licensed by the Florida Department of Financial Services or not authorized to sell insurance for a specific insurance company. If you purchase a policy from an unlicensed or unauthorized agent, the policy is not valid and you will not have coverage. 

    Consumer Tip:
    • Be sure that your insurance company or agent is licensed to do business in Florida.

    To Verify an Insurance Company License:

    Office of Insurance Regulation
    Active Company Search
    www.FLOIR.com/CompanySearch

    To Verify an Insurance Agent License:

    Florida Department of Financial Services
    Division of Insurance Agent and Agency Services
    www.MyFloridaCFO.com/Division/Agents
    850.413.3137

      Automobile Insurance Scam Shield

      AUTOMOBILE INSURANCE SCAMS

       

      Repair

      Repair Scam

      Unnecessary repair(s) or pretending to repair a vehicle in order to file a fraudulent or inflated insurance claim or to access your personal information. This type of scam also occurs with homes and other property. 

      Consumer Tips:
      • Check with your insurance company before making repairs to your vehicle, home, etc. to ensure you follow policy guidelines and policyholder obligations. 
      • Verify that repair companies/vendors are legitimate, and have the proper liability and workers’ compensation insurance coverage. 
      To Verify Workers’ Compensation Coverage:
      Florida Department of Financial Services
      Division of Workers' Compensation
      www.MyFloridaCFO.com/Division/WC
      850.413.1609

      Staged Auto Accidents


      Staged Auto Accident Scam

      A person(s) intentionally causes or stages an automobile accident in order to file fraudulent or inflated insurance claims with your insurance company for repairs, injuries, etc. 

      Consumer Tips:
      • Document as many details of the accident that you can recall to share with law enforcement and your insurance company. Details may include your potential speed, traffic conditions at the time of the accident, presence of traffic lights or stop signs at the location and if applicable, any behavior of the other vehicle before the accident (example: trailing you closely before the accident).
      • Retrieve as much information, including contact and insurance information, from the other driver, if possible.
      • Let law enforcement and your insurance company know if you have any suspicion the accident may have been staged or caused intentionally. Be sure to include any details that support this suspicion.
      Health Insurance Scam Shield

      HEALTH INSURANCE SCAMS


      Medical ID Theft

      Medical Identity Theft

      A person using your identity and insurance to obtain medical services or prescriptions. 

      Consumer Tips:
      • Don’t allow anyone to use your insurance card for services or to make fraudulent insurance claims. 
      • Check your credit report to ensure no one has opened new lines of credit in your name for the purposes of receiving medical care, i.e. credit cards that specifically cover medical or dental procedures. Visit www.AnnualCreditReport.com to review your free credit report.
      • After receiving medical claims, your insurance company may provide you with an Explanation of Benefits (EOB), which is an overview of all of the services or prescriptions billed, fees that the insurance company paid on your behalf and your financial obligations. It also lets you know that the company has processed your insurance claims. Review your EOB to ensure no unauthorized medical services or prescriptions are listed or were billed to your insurance company. If there are unauthorized entries, contact your insurance company immediately. 

      Fraudulent Medical Charges

      Fraudulent Medical Charges

      A medical provider charges for services that were not performed or falsely inflates the cost of services in order to file fraudulent insurance claims with your insurance company and receive payment.

      Consumer Tips:
      • After receiving medical services, your insurance company may provide you with an Explanation of Benefits (EOB), which is an overview of all of the services or prescriptions you received, fees that the insurance company paid on your behalf and your financial obligations. It also lets you know that the company has processed your insurance claims. Review your EOB to ensure no unauthorized medical services or prescriptions are listed or were billed to your insurance company. If there are unauthorized entries, contact your insurance company immediately. 
      • Don’t allow anyone to use your insurance card for services or to make fraudulent insurance claims. 
      Homeowners Insurance Scam Shield

      HOMEOWNERS INSURANCE SCAMS

       

      Offers to Sell or Increase Insurance Coverage During a Disaster

      Offers to Sell or Increase Insurance Coverage During a Disaster

      A person(s) pretends to represent an insurance company and offers to sale or increase your coverage immediately before or during a disaster. When the National Weather Service issues a hurricane or tropical storm watch or warning for any part of Florida, many insurance companies cease binding new or additional homeowners or renters’ insurance coverage. When this occurs, insurance coverage cannot be purchased until 72 hours after the last watch or warning has been lifted. 
      Consumer Tips:
      • Be leery of unsolicited calls. Companies should not call you unsolicited requesting personal information or ask you to verify details of your insurance coverage.
      • Do not trust the caller ID. While the name and number may appear to be that of an insurance company, it may be a scam artist attempting to obtain your personal insurance information.
      • Purchase and make changes to your insurance policy through a licensed insurance agent or your insurance company directly. Verify identity before making any payments or providing personal information. 

      Unlicensed Contractor

      Unlicensed Contractor

      A person represents themselves as a licensed, professional contractor when, in reality, they have not been licensed by the Florida Department of Business and Professional Regulation. The unlicensed “professional” may also misrepresent their workers’ compensation and/or liability insurance coverage to give the impression that they are properly insured. Unlicensed contracting work is illegal and dangerous for you, as a consumer. Using an unlicensed contractor can put you at risk of receiving unsatisfactory, subpar repairs, which could potentially cause more issues in the future or even cause severe injury to you or someone visiting your property. 

      Consumer Tips:
      • Verify the contractor's license status with the State of Florida to ensure they are licensed and in good standing. 
      To Verify Contractor License:
      Florida Department of Business and Professional Regulation 
      www.MyFloridaLicense.com
      850.487.1395

      • Verify that contractors and repair companies are legitimate, and have the proper liability and workers’ compensation insurance coverage. 
      To Verify Workers’ Compensation Coverage:
      Florida Department of Financial Services
      Division of Workers' Compensation
      www.MyFloridaCFO.com/Division/WC
      850.413.1609
      COVID-19 Fraud & Scams
      For information on COVID-19 scams:

      COVID-19 Fraud & Scams Page

      • Overview of current COVID-19 fraud and scams including contact tracing scams, COVID-19 testing kit scams and COVID-19 medical supplies scams.
      • Federal Trade Commission's daily updated COVID-19 and Stimulus Fraud data statistics map

      Contact the Office of the Insurance Consumer Advocate


      Office of the Insurance Consumer Advocate
      200 East Gaines Street, Tallahassee, FL 32399
      Phone: (850) 413-5923
      Email: YourFLVoice@MyFloridaCFO.com

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