The Sweet Little Old Lady & Fraud
Insurance Fraud is an Equal Opportunity Crime
The Insured was 82 years old and bored. She was born shortly after the turn of the century to a wealthy family of Connecticut merchants. She had been a debutante. She lived most of her life in luxury. Now, at 82, she was a widow living alone. She had a small income from her husband’s estate and 82-years-worth of things.
The things bored her. Living alone bored her. Simply passing the days caused her nothing but unexplainable exhaustion. Her life needed something to keep her interest. The Insured, regardless of her age, had a fine and steady hand. Her penmanship was, in these days of computers, exotic.
The agent responded, with sympathy: “Being burglarized is nothing to be ashamed of. It happens every day. That’s why you bought insurance. What was taken?” “Everything, all my fine things.
They are all gone.”
Lloyd’s directed a local adjuster to investigate the claim. When he arrived at the Insured’s home he found minimal furniture in relatively poor condition. He found the Insured to be a pleasant old lady who stood only five foot one inches tall. She was thin and frail looking and could not have weighed more than ninety pounds.
She told the adjuster: I had hired a lady from El Salvador to help me clean my silver. It’s just too big a job for me now that I’m 82. Her name was Juanita. I don’t know her last name. I believe her number and name was on a card on the bulletin board at the Ralphs grocery store. Juanita and I had been cleaning the silver for about an hour using very strong ammonia when the fumes began to bother me and I became faint. I really don’t know what happened, but the next thing I remember I was waking up on the kitchen floor. Juanita was gone. Upset at the calumny of the El Salvadorian domestic the adjuster wanted to help.
He promised to complete his investigation rapidly. He would make sure her claim was paid as promptly as possible. The adjuster had been well trained. He knew that Lloyd’s underwriters expected him to verify the appraisal with Mr. McCarthy. He knew that they also required that the claims handler verify the values of the things claimed stolen.
A fraud was thwarted. The Insured put some excitement into the dull life of an 82-year-old widow. Little harm was done and the adjuster has a story about a fraudulent claim that will top that of all his contemporaries. Because they rescinded the policy Lloyd’s returned the premium.
ZALMA OPINION
Insurers must, to conduct a thorough investigation without bias, stop the criminal actions of sweet old ladies or hardened criminals equally. If not, crime will succeed. The innocent ex-convict will lose the indemnity to which he is entitled. The criminal grandmother will recover and everyone who buys insurance will pay more than they should.
(c) 2022 Barry Zalma & ClaimSchool, Inc.