Several Factors Hinder Homeowner and Auto Glass Insurance Fraud Processing
Report 21-05, March 2021
OPPAGA reviewed how effectively the Florida Department of Financial Services’ Division of Investigative and Forensic Services (DIFS) and prosecutors handle homeowner and auto glass insurance fraud, as well as factors that may be driving increases in fraud reports.
- Most reports of suspected insurance fraud (i.e., referrals) from Fiscal Years 2014-15 through 2019-20 came from insurance companies, which are required to maintain a special investigative unit (SIU) and report suspected fraud to DIFS. In recent years, reports of suspected homeowner and auto glass fraud to DIFS have increased substantially. Overall, homeowner fraud referrals followed Florida’s population patterns by county. While auto glass fraud referrals also occurred throughout the state and generally followed population patterns, some large counties have fewer referrals than expected given their population size.
- Most suspected fraud referrals were closed without resulting in a subsequent fraud case because they lacked sufficient evidence to proceed, and most fraud cases did not result in successful presentations to prosecutors for similar reasons. Regardless of outcome, evaluating fraud referrals and investigating fraud cases can take months. DIFS staffing issues affect the division’s ability to investigate complex insurance fraud cases.
- Stakeholders suggested several options to deter fraud and improve the quality of data DIFS receives from insurance companies. These include eliminating one-way and contingency risk/fee multiplier fee provisions, restricting assignment of benefits guidelines for auto glass claims, reducing the time allowed for submitting hurricane/windstorm homeowner claims, revising statutory requirements for insurance company fraud reporting, providing for SIU auditing, and modifying the Anti-Fraud Reward Program.
homeowner, insurance, auto glass, fraud, Department of Financial Services, DFS, Office of Insurance Regulation, prosecutors, referrals, cases, windstorm, fee multiplier, insurance company, investigation, prosecution, claims