# insurance fraud



## MJW (Jan 27, 2006)

First off, I am tired of giving bids for insurance work already. I haven't had much trouble yet, but here are some scenarios. Tell me what you know about the legality of these.

scenario 1

-customer uses my bid of 12K for insurance claim. They get the 12K minus their deductible and depreciation. 
-neighbor comes over and says he will do the job for 8K, homewoner pockets remaining 3-4K

scenario 2

-customer's insurance adjuster gives them a claim estimate of 12K. 
-fly by nighter says he will do it for 8K.
-homeowner pockets 3-4K

scenario 3

-customer gets ins. claim of 12K
-newby says he will do it for 8k
-now customer wants me to lower my price
- my name on 12K check,but only receive 9K for the job
-homeowner pockets 2-3k




We have been running into this on some bids because of all the people out of work. I know, you can tell them you will get a better job with me (and definitely will) and explain how our system works better, but no one is going to turn down 3-4K in their pocket with the economy now.

Any insight here???


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## genecarp (Mar 16, 2008)

no insights, i just posted a similar thread 2 weeks ago. ins work has always been like that.


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## rbsremodeling (Nov 12, 2007)

I haven't done many insurance jobs but the checks were always made payable to me and the homeowner or to me


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## mdshunk (Mar 13, 2005)

I find a general trend among guys who don't normally charge for estimates to charge for insurance estimates just for this reason. They turn into real jobs far less often than the typical estimate. "Refundable if we do they work", they say. Sorts out the people who have no real intention of hiring you.


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## MALCO.New.York (Feb 27, 2008)

Only the third scenario is "Fraud".


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## MJW (Jan 27, 2006)

As far as I know, pocketing excess ins. money is not legal. Most paperwork says to return excess money. That not correct?


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## AtlanticWBConst (Mar 29, 2006)

We have done alot of insurance repair work over the years.

Similar Example: My business partner's brother built a salon (for a client) about 20 years ago. 

Salon has a fire about 15 years after opening. The owner gets estimates for repairs. He decides to hire my buiness partner's brother to do alot of it, as a sub contractor (pays hime well by the hour), while he (the owner) "GC's" the restoration. Owner hires relatives and friends to do alot of the work. He also does alot of it himself (cleaning, painting, etc.)
He ends out coming in $20K ahead. Is it legal? Yes. He did his part on the work.

Another Example: You get into a car accident. Insurer pays you for the damages. The car is paid off, and you decide to fix the damage with a can of spray paint = legal.


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## MJW (Jan 27, 2006)

That is exactly the difference....the car is paid off. Legally a mortgage company ultimately owns a home, unless it is paid off.

I know people do it, but paying yourself to do work isn't what insurance money is for. If you look up insurance fraud, there are plenty of cases for this that are similar. Grand theft and ins. fraud.

This is just what I read. I was wondering if anyone knew for sure what is legal and what isn't.


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## MALCO.New.York (Feb 27, 2008)

MJW said:


> As far as I know, pocketing excess ins. money is not legal. Most paperwork says to return excess money. That not correct?


So when the Insurance Company cuts me a check for "X" for the damages to my car and I decide to do NO repairs, it is Illegal. NOPE! It is used AGAINST a Fair Market Resale Value Index.

You are entitled to this.


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## MJW (Jan 27, 2006)

You are right, but you take the loss on a vehicle. A mortgaged home is different.

Ever read any insurance claim papers?


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## dougger222 (Jan 29, 2004)

Joe, 

It happened to me a number of times last year. I was able to have enough honest home owners it really didn't hurt by bottom line but it did bother me at times.

Let the hacks do their roof and next time make them sign a contract for what you get the insurance company to pay.

I like banks like US Bank who cuts the insurance money with my name on it.

Had one last year that after four trips and after pulling some strings got the insurance company to pay $12,400 for a roof they originaly wanted to pay $7,500. He had a crew of illegals do it for half I would guess and they didn't re-deck or do the garage roof. I turned him in for insurance fraud and as far as I know nothing became of it. He's my old neighbor and my mechanics neighbor. Sad to say but I hope all his shingles blow off next wind storm. The shingles are already buckling in spots and it's only 8 months old. Would have done the whole block if it wasn't for this low life.

Just call their insurance company and mortgage company and let them know whats going on.

I like to let the insurance company know that I don't want my good name tied to a roof I didn't do.

So far this year have not had this happen to me yet, but it will. So swamped with work really don't care right now.


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## MJW (Jan 27, 2006)

I have a small write up I will be sending to the local news channels. We'll see if anything becomes of it. I think it would be a great story with all the storms around.


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## Slyfox (Dec 22, 2007)

We had a hail storm in Austintown couple years ago where some thing like 7 city blocks got hammered,
i get a call from a HO just outside of the area who says the guy who lives directly behind him found he had damge and ask if i will check his roof for him,
I do and tell him, sorry sir, but your roof is fine as is your siding etc.
10 days later the guys calls me back, hey, i called my insurance company and had them send a rep out, cost 250.00 for the service call if no damage is found, and he says i do have damage, come and give me an estimate!.

I have been roofing my entire adult life, done hail damage and other storm damage work in a dozen different states, i know what a damaged roof looks like, lol, so how did the insurance companies rep find what i couldn't, side pocketing some cash? or what.

I got the job too, and made good money on re-roofing, siding and new gutters, but he got everything done for no appearant reason that i could see.


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## Ed the Roofer (Dec 12, 2006)

This is some novice adjusters version of hail damage on a home I just estimated.

I wish some of the legitimate ones I see where this easy.

I had a few other shots that I did not resize down far enough, but you get the gist from these samples.

Ed


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## Patrick (Apr 12, 2006)

LOL that ridge vent was probably dented 2 re-roofs ago. Why do people reuse those? Err Why do people still use those period. BTW, Ive never seen one that wasn't dented.


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## Ed the Roofer (Dec 12, 2006)

Thats an original roof from a home only 11 years old.

I am sure all of those dents came right out of the box.

I should go and re-resize those other photos, because it is rediculous what gets paid for sometimes as Hail Damage and what does not.

Oh yeah, the dents that can not be seen devalue the home, but the exposed rustly nails and screws and improperly installed metal sections of ridge vent with no splice connectors installed and caulking totally degraded from the sun and expansion and contraction do not. WTF!

Ed


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## MJW (Jan 27, 2006)

Just an update, the news channel emailed me back and thought I had a great story idea with these insurance claims and people deliberately getting bids to pocket money. They are contacting other experts on the subject. If anyone has any good info to share I can pass it on. This has got to stop.



I agree Patrick, that ridge is JUNK!


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## wizendwizard (Nov 11, 2007)

:thumbsup:


mdshunk said:


> I find a general trend among guys who don't normally charge for estimates to charge for insurance estimates just for this reason. They turn into real jobs far less often than the typical estimate. "Refundable if we do they work", they say. Sorts out the people who have no real intention of hiring you.


Dead on right!


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## Patrick (Apr 12, 2006)

Its not just in storm country. Dealt with a guy over the winter trying to get rich off the insurance company. He was pretty bold, and open about it, expecting me to sit by while he collected a check for 3 times what he was gonna pay me.


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## OCRS (Apr 29, 2008)

My old neighbour (from where I previously lived) had a flood that was covered by insurance. He came to me to ask if I could quote the repair. I've had experience with this guy before. So I had to say to him "****, do you want me to quote this job because you know I do good work and you can trust me, or are you just trying to line your pockets?"

He says "no, no, I want you to do the work". The next day he comes to me and says " I found out what the adjuster evaluated the job at and I think I can do most of it myself, I just need you to patch some drywall. Oh, can you give me a quote on the whole job?"

I said "not interested ****". The next day after that a rust bucket pickup shows up with some drywall and compound in the back. I guess he found someone to do what he wanted. I'm assuming the insurance company paid him and he just paid for the patching work.


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