(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.)

(0:00 - 0:13) He bought two newer cars from two legit dealerships. Both ended up stolen in two different high theft zones of Portland, Oregon. And both times, he had no idea where he had parked them.

(0:14 - 0:34) No security footage, no eyewitnesses. And when I asked who he was visiting, he shrugged and said it was a friend. Gave a first name only, no phone number, and not even a last name address.

Just a vague story. Twice. But here's the twist.

(0:34 - 0:47) I handle both claims. And the moment I saw that name come across my desk a second time, I knew something wasn't right. Fidgety, evasive, parroting the same lines from the first time.

(0:48 - 1:47) This wasn't just bad luck. It was deja vu. And what I uncovered next unraveled more than just a claim.

It exposed a pattern of deception that might have gone unnoticed if I hadn't been paying attention. Welcome to another episode of Top Priority Chronicles, where we share real life wisdom that has been learned from my years of experience in the private investigation field. So today's episode is titled, Twice Stolen, Twice Suspect, Deja Vu in Portland.

(1:48 - 4:58) So I am an investigator here in the state of Oregon. I primarily investigate in the city of Portland, but I travel not only in Oregon, I also travel in Washington and other states at times, depending on the nature of the work. But the bulk of my work is primarily done in Oregon, which is where I'm licensed.

This case was a second claim to a claim that I had previously handled and was the same claimant who had filed the first claim. The suspicions around this claim was around the fact that the same exact thing had happened, which was a report of a stolen vehicle, two different parts of town, but exactly the same story. The first time around, the claimant actually lived in Tigard, Oregon, but yet was reporting a car stolen in North Portland, actually the Mississippi area, which is a high vehicle theft area.

So it was a newer model vehicle. He had parked it on the street and when he reported the claim, he couldn't give us an exact location of where the vehicle was parked. So he just gave us a a circumference of where he could have parked the area.

And so in looking for surveillance footage of the area or neighbors who may have had any surveillance cameras, we were unsuccessful and therefore we could not even verify when and if the vehicle was parked in that area. The vehicle was purchased with a cash purchase and meaning that there was no loan taken out on the vehicle. It was paid flat out upon purchase and that meant that there was no ongoing contact with the dealership and the purchaser of the vehicle.

The gentleman who purchased the vehicle and made the claim the first time around was cooperative. He turned over all the information that was requested from the insurance company and what was more suspicious is the circumstance around his claim and his inability to tell us where his friend lived to allow us to verify and to verify where he had parked the exact location. The second claim the gentleman had reported he went to another friend's house downtown Portland.

(4:58 - 7:53) This time around he could not even give us a first name and he could not give us an exact location. He could also not give us an exact location of where he parked. He told us in the vicinity in which we parked in which we started asking for surveillance footage from local businesses and which we had a lot more luck downtown finding businesses and asking for surveillance footage around the time he had reported being downtown.

I think what raised red flags for me was for maybe one time you might forget where you parked but on two different occasions you don't remember where you park and you don't know the address and contact information of the friend you're visiting. That just didn't seem plausible for me and it just didn't seem to be true. So you know he was unable to verify the visits.

He was also in a high theft and high drug areas. Both areas were high theft of vehicles and highly areas that drugs are highly sought after in. So it also raised a red flag.

As I stated earlier there was no proof but there was a suspicion of substance use because he the gentleman was evasive and giving us the information that we needed as far as verifying the friend you were visiting and where the vehicle was parked. His fidgeting behavior, his just being vague and just not being clear just continued to raise red flags for me and as a investigator what I've learned is that it's important to pay attention to patterns. If you are seeing things that just don't add up it's one time for it to happen in one claim but for a second claim to come through and the same concerns of fraud pique your interest even though the first claim got paid out that that's totally up to the insurance company but as an investigator if I see something it's imperative that I say something and so I did.

I raised the red flags I have to the case manager that I was working on behalf of. When I did make contact with the claimant I had to verify the purchase and ownership records by contact getting proof of purchase from the gentleman all of the records he received when he purchased the car. I also had to contact the dealership directly to confirm the documents he shared were authentic and the original documents that were given to him that day.

(7:54 - 23:20) Also to map out timelines and to try to get a brief outline of what his schedule entailed that day what he did before what he did after and this gentleman was very vague in his not only his friend who he was visiting and where he parked but also what he had been doing before and after why he was visiting this friend who this friend was to him he just was not able to answer any of those questions and when asked he was defensive and arguing his right to privacy so again those things raised red flags to me. Once I collect all that data I put together a nice report and I submit it back to the special investigations unit that I am working with. The challenge with fraudulent claims is that most people don't anticipate getting caught and so you don't expect that your claim is going to be that there's going to be a problem with the claim so if if fraud is suspected in a claim it's going to delay the claim for sure and potentially a denial of the claim.

Another possible outcome is that your claim not only your claim but you as an insurance holder could be flagged in fraud databases. There are two particular ones one is held by the National Insurance Crime Bureau which is also known by their acronym NICB and they are a non-profit partnership between law enforcement and insurance companies where they hold a database that detects potential fraudsters and tracks them and flags their insurance case insurance claims and their files and they could also do their own investigation if fraud is found by the insurance company and your case is referred to them. Another fraud database is held by the insurance services office which is a private data analysis company and the insurance company also uses them to detect fraud by using by the the data that they analyze.

So just know that if you've done it before and if you have a pattern of committing fraud or being referred to SIU there's a very good chance that you could be referred to those databases and you could have the possible outcome of having your claim denied. You could be referred to prosecution in extreme cases and you could increase you could receive yourself increased underwriting scrutiny so when you go get a new policy renew a policy or go get a new policy with another insurance holder they could hold up your claim by requiring extra additional information and or taking longer to approve your or even deny your request for insurance. You also could be run the risk of being dropped by your current insurer and denied new coverage by any other insurer.

So it is very important that you know if there is a suspicion of fraud that you provide documents that are requested of you. You be not only just cooperative and nice but you be able to verify whatever it is you're claiming that happened. If you visited a friend be able to provide a name and address and phone number for the insurance company to contact and verify.

If you park somewhere be able to verify that parking and most new cars have this data tracking system that it can even track where you've driven and when you got there how long you were there and how long it took you know how long you drove to get there and so if you have a newer car insurance companies are able to contact dealerships to get that information even if you don't share it. So I think that it's important that you know that insurance companies have a way of getting information around you even if you don't provide that information. So I just this case was very interesting case because for me I was just investigating the case.

I don't have any say so in the final outcome but for me it looked like it was a blatant kind of cut and dry easy to spot easy to detect fraudulent claim. The second yeah the second claim when the gentleman was from out of state and he just was strange just you know there's no other way to put it that his behavior was strange his partner's lack of desire to be involved in reporting the claim of you know sharing any information about the claim. The second time around the first time both they had both fob keys that came with the new vehicle.

The second theft the spouse was missing his fob key so there was only one fob key that was returned to the insurance company which again for me was another red flag because one thing that I do know I don't know what happened to the vehicle and I you know but one just knowing about drugs and the drug world and that you can rent cars out or you can even sell a brand new car to people that may not be able to go out and buy one. There's a whole underground for fraud and criminal behavior and this gentleman was a middle-aged white male and for those who are into statistics statistically white men are have been convicted more often for insurance claims and white collar crime so I just threw that out there that he met that criteria as far and then on top of all of this other suspicious behavior it really just kind of red red flag for me and allowed prompted me instead of just returning just the information to go the extra mile and put in the red flags that were listed right in what things that I could not prove but that you know feelings that I got in my gut that would just and you know try to explain the best I can where those feelings came from and what experience I had that allowed me to to draw those conclusions so first off don't if you are you know if you value having your auto insurance I encourage you not to commit fraud because it could come back not only on you but it could come back also to harm the folks in your household it can become more difficult to be able to have car insurance and without car insurance you know you just a ticket or possible arrest waiting to happen so before departing I just want to reiterate how sometimes it's not the lie that makes it so obvious it's the repetition if you're gonna I don't want to encourage anybody to do the wrong thing but if you're gonna be a fraud and if you're gonna lie at least spend the time and make up a new story not encouraging fraud but these were my thoughts to the gentleman in the claim how investigators walk the line between empathy and accountability can be a challenge because in our mind maybe this person looks guilty and should be held accountable but as the investigator we know we are not judge or jury and we don't have the final say and we don't have authority over that over the insurance companies right to honor or deny that claim the only thing we are called to do is gather information gather intel behind the scenes to be able to give it back to the insurance company to help them make an informed choice so that is you know the nut and bolts of an investigator's role is that we collect information that may that the you know whoever we're working on behalf of whether it be an insurance company an attorney a a a business a an individual or a family and just to know that fraud isn't always obvious or loud but it's often lazy and repetitive so first you know i reiterate don't become a fraud and if you are a fraud i encourage you to not just because you can you know you can fool some people some of the time but you can't fool everybody all the time and so i just if you haven't gotten caught i'm just hoping this is on your conscious to like help you to be grateful for what you may have already gotten away with and um and if you have never even thought about such a thing i just applaud you and encourage you to continue to do the right thing but knowing that even making an honest claim doesn't mean that things don't rise to the suspicion of needing special investigations unit to be called out to follow up on your claim i just encourage you and implore you to be forthcoming to provide all the information the insurance company is asking for and if there's any gaps or any information you aren't able to provide to the best of your ability be able to explain that to the insurance company or to the investigator who is handling your claim so they can be able to best and better explain it back to the insurance company so they can understand your position which gives them you know if you have someone else advocating for you on your behalf and that's basically what i as the investigator do i advocate to the insurance company as to if this claim should be granted and if there's enough evidence to support this claim and so i just want to give you the best chance at having your claim honored by telling you what is necessary and what to not do to avoid having your claim flagged for fraud so just um in closing i just want i want to let you know that when a story doesn't evolve and in this story we couldn't get past his car was stolen we didn't know where he was before what he was doing before you know we couldn't even put the story together to be honest and so that in itself was a red flag and what you need to know is that if the story doesn't evolve then most likely it is not true and so that is the conclusion that i came to in this claim and that's the information i reported back now whether that claim was granted or not i didn't follow up or i didn't have the privilege to have a third claim to even be able to get any follow-up information which was um this was um a um a different kind of case because i did get a claim on the same person with a similar claim and this has never happened before and so it gave me a chance to know that that first claim was honored because of having to follow up with the dealership and seeing how the second car was paid for so i must say that was the nice thing about this case is being able to see how a claim that you handled before turned out so um with that being said i want to thank you again for watching another episode of top priority chronicles this episode was meant to educate and to hopefully deter deter anyone who is thinking about fraud or may have experienced fraud or may have been suspected of fraud and if that happens that you know that it's a normal part of the insurance process and that the more you communicate the better you communicate with your insurance claimant and case managers and everyone involved the smoother the claim gets resolved and as an insurance claimant just know that you also have the right to complain if you're being accused of fraud and you don't think they have the basis in in coming to that conclusion you don't feel like they have the appropriate information to come to that conclusion you can also file a complaint i um i would encourage you to look online and find out who that would um who you'd file that complaint with i didn't do i didn't bring all that that information with me here tonight but that is something that is uh available to you i believe it's an impossible insurance ombudsman um but there's also a lot of resources out there for people who have difficulty with insurance claims because i've also um working as an investigator i've also worked with claimants who had um someone from when they called and made a complaint they had an ombudsman accompany them to the recorded statement so they could um and it served almost like an attorney to support them and to let them know what their rights were during questioning to let them know you don't have to answer that or that's going too far that's asking for too much information too much reach too broad of a question and so know that that is available and so if you ever have a insurance claim and you have to give information a recorded statement know if you have any reason to be nervous or valid or not for your own safety you have the right to ask for a um support and so just know that the insurance company isn't going to volunteer that information you can ask them and ask them how do you go about getting that information doesn't mean you'll get it but if you do your due diligence online i'm sure you will find it and so again it's been a pleasure spending this week with you until we see each other again have a blessed week

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