A claim adjuster for the second-largest insurer in the country had his five-year-long fraud scheme sunk by a Sink.
Acting on an anonymous tip, Florida CFO Alex Sink’s Division of Insurance Fraud (DIF) arrested five fraudsters, including Donald Alfred Toohey, III, who had been working as a claim adjuster for Zurich Insurance Group.
According to the National Association of Insurance Commissioners (NAIC), Zurich was ranked second largest insurer in the U.S. by premiums collected across all lines of business in 2009.
According to a release posted on Sink’s web site, DIF detectives received the anonymous tip in September 2009 that alerted them to possible fraudulent activity by Toohey. The resulting investigation uncovered that Toohey and four other individuals — Scott J. Kincaid, Brian Frederick Kneifer, Anthony Michal Kneifer, and Tricia Ann Allen — were committing insurance fraud and other illegal acts.
The scheme went down like this: Toohey would create fictitious and fraudulent claims by abusing his access to the paperwork used to file the fraudulent insurance claims. In many instances, "reimbursement" was for injuries that occurred either to the person or their automobile during an accident. The participant/partner in crime would then receive a check in the mail with the understanding that a portion would be paid back to Toohey.
Each participant allegedly received payments from 26 different claims totaling more than $240,000 from August 2004 through June 2009. Three or more checks were received and cashed by each of the four individuals, with thefts ranging from $8,800 to more than $67,000.
If convicted, each defendant faces up to 15 years in prison.
See Also: Fraud of the Week: An Inside Job