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Just ten days ago, a Los Angeles area injured worker, Rev Anthony T. Johnese, wrote to this writer and inquired, “I was curious to know if you ever write about fraud from adjusters, lawyers, or insurance carriers.”  I wrote back and replied that I did. I pointed him to a few articles I had penned back in 2009 about three experienced Southern California workers’ compensation claims adjusters, Hector Porrata, Cara Cruz-Thompson, and Rene Montes, who had embezzled over a million and a half dollars from A.I.G. and Matrix Absence Management. They were prosecuted by the Orange County District Attorney’s office.

Then there’s the case of Leticia Berry, applicants’ attorney Robert Pearman’s paralegal, whose offices are in Van Nuys, California.  She stole $42,000 from a client workers’ compensation claimant in October and November of 2013.   

I know carrier fraud exists, but I haven’t followed a case about one yet.  Then today a story out of a British newspaper jumped out at me which clearly demonstrates a very clever carrier fraud.

The Independent of the UK reports today that in November of 2016 the issue of insurance companies targeting Brits on holiday in Spanish resorts and encouraging them to make false sickness claims began to make headlines. Certain insurance carriers solicited British vacation travelers going to Spain to buy a type of travel insurance that covers illness while on holiday.  Many of these Brits had purchased all-inclusive packages at hotels in Spain for bargain basement prices, such as 1000 £ for two weeks.  Henceforth, they were lured by insurance carrier fraudsters to buy insurance which would allow them to recover £2000 to £3000 if they filed a food poisoning claim.  This would pay for their vacations two to three times over.

All of the claimants have been British.  A law firm, Rogers & Co., that represents the collective insurance industry, had a representative, David Diez Ramos, tell Travel Weekly, “Sooner or later Spanish hotels will increase the price or stop selling all-inclusive to Britons.” 

David Diez Ramos expressed that “Ten claims of this kind a month would hit hoteliers’ profits.  They have to transfer the risk to the consumer [or] hotels might be forced to move away from all-inclusive.  Spanish insurance companies are going to increase the premiums or the excess or not insure this risk.  We have no options.” 

The CEO of Thomas Cook, Peter Fankhauser, stated that these food poisoning claims are coming at a time when levels of customer satisfaction are rising.  He is concerned that Spanish hoteliers running their most popular hotels could stop taking British people.  He said, “In a deeply worrying trend, it would seem many of the claims are questionable, to say the least, with holiday makers seduced into making them by rogue companies which promise payouts of several thousand pounds.” 

Fankhauser, along with a travel and tour operator association, called for new development of stricter laws.  “It is time the government looked to change the law in this area,” he told The Independent, “Action needs to be taken against the rogue claims companies.  Some couldn’t be more brazen, sitting outside Spanish hotels in ‘ambulances’ and promising holidaymakers payouts.  This must stop.” 

Spanish Hotels Could Scrap All-Inclusive Holidays For Brits

lonce@adjustercom, journalist Lonce LaMon.