West Virginia Offices of the Insurance Commissioner 2009 Annual ...

The Inspector General and or his designee have appeared on “Inside Insurance”, a television
show airing statewide on PBS, with the programming airing sixty-six (66) times, for a total air time of
over thirty-three (33) hours of programming dedicated to the issue of insurance fraud and how to report
such to the OIC’s Fraud Unit. Further, numerous interviews have been done with various media outlets
around the state concerning efforts to combat insurance fraud in the state. Media interviews along with
quarterly newsletters being distributed to the public and the insurance industry enhance the visibility of
the Fraud Unit in its goal to educate the public on what constitutes insurance fraud and what can be
done to prevent it. Further, numerous presentations have been given to a wide range of groups and
organizations on what is being done to combat insurance fraud in the state and what they can do to
assist in those efforts. Statistics for activities conducted by the Fraud Unit during calendar year 2009
are depicted in the following chart:
Referrals Received for Calendar
2009
Claimant ant WC
C 123
3
Employer WC C
60
General Insurance
Public 642
General Insurance
Industry 31
Medical Vendors
16
Total = 872
R ef efe r r al als Re Rece ceiviv e d ffo r Ca Calele n d a r 20 2009
09
C laimant laimant WC WC
Employer WC WC
General General Insurance Public Public
General General Insurance
Industry Industry
Medical Medical Vendor Vendorss
Successful investigations resulting in prosecutions were conducted in numerous counties
through out the state. Prosecutions involved such activity as workers compensation fraud;
conventional insurance claimant fraud; staged motor vehicle crashes; fraudulent “slip, trip, and fall”
claims against businesses; insurance fraud by means of arson; and embezzlement of policy holder
premium funds by insurance industry personnel. Such successful prosecutions were the result of
working in cooperation with local and state law enforcement agencies and locally elected prosecutors
as well as the two (2) U.S. Attorney Offices. As a result of thorough investigations and well prepared
reports, along with efficient case management of referrals, significant increases in every category were
realized. For example, individuals arrested or indicted increased 33%, and the number of felony counts
increased 61%.
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