AUS Branch Insurance Industry Investigation of the Year
Nominations Deadline: Jan 25, 2019
The Insurance Industry Investigation of the Year Award is open to any individual or team working in the insurance industry who have conducted an outstanding investigation of a suspicious motor vehicle claim, or a network of suspicious motor vehicle claims or any auto crime claims (staged accident etc.). The award is open to both investigators who have conducted an outstanding investigation into motor vehicle theft claims, auto crime claims, and claims staff working in the investigations unit of an insurance company who manage the investigation process.
The investigation may be deemed outstanding for a range of reasons including its use of innovative methodologies and investigations techniques; the complexity of the investigation and the outcome of the investigation. The submission could be in relation to one specific claim, a network of theft claims or auto crime claims that were identified and investigated. The investigation and/or insurance claim must have been performed in either Australia, New Zealand or South East Asia in the past three years.
This award is sponsored by Polonious.
The recipient of the award will receive up to $1,500 towards the costs of the winner in attending the 2019 Annual Seminar and the presentation dinner.
For more details on the judging criteria, conditions and how to nominate please download the documents on the following page 2019 Australasian Awards and Travel Scholarship - Call for Applications
Click the ‘View’ button to see a list of winners of this award.
2018 Insurance Investigation of the Year
Sponsored by Polonious
Ralph Bach of Nexus Investigations was unfortunately not present to receive his award due to other commitments at the time of the Awards Dinner. He was nominated by Chris Loane of Vendor Management Australia who accepted the award on his behalf.
Ralph was involved in a complex Insurance Investigation which required the coordinated efforts of a Forensic Locksmith; a Mechanical and BMW data specialist; an Accident Reconstructionist with “Infotainment” data retrieval and analysis skills; a Factual Investigator, and a dedicated Police Officer, who later brought the matter to a successful conclusion in the Courts.
Throughout the conduct of this Investigation, Ralph Back from Nexus Investigations carried out a very through factual investigation. Ralph liaised with the forensic examiners and assisted them with information and clarification around the claim circumstances and the information and answers provided by the Insured and family members about the claim; the vehicle and its use; the location and existence of keys; the use of the vehicle and the date and time and manner in which it had allegedly been stolen and other related issues.
The manner in which Ralph carried out his inquiries and conducted his interviews in a thorough and professional manner, was a significant contributor to the success of this Investigation process.
2017 Insurance Industry Investigation of the Year
Sponsored by Polonious
Jay Properjohn (left) winner of the 2017 AUS Branch Insurance Industry Investigation of the Year. Seen receiving his trophy from Award Sponsor Alastair Steel, Polonious
2016 Insurance Industry Investigation of the Year
Sponsored by Polonious
Alastair Steel from Polonious (left) presents Matthew McKee with his 2016 Insurance Industry Investigation of the Year trophy.
2015 Insurance Industry Investigation of the Year.
Sponsored by Polonious Case Management Solutions.
This investigation was in regards to a stolen 2012 BMW 335i sedan, which was reported to have been stolen without the use of the insured parties keys. The vehicle was insured for agreed value of $92,000 and had not been recovered.
Mathew’s investigation was able to discover sufficient information to suggest that the claim was fabricated for the purpose of making an insurance claim. Through the forensic examination of the vehicle keys it was discovered that:
- The keys were correctly coded to the Insured vehicle VIN
- Keys to this model of vehicle could not be cloned
- One key fob showed signs of regular wear, and the other did not, consistent with the Insured’s evidence.
- The key fob showing signs of regular wear had been last used in the car at 11.51am.
- The key fob showing sign of little or no usage was the key that had last been used in the car at 12.05pm, i.e. 14 minutes after the main use key used by the Insured. It was driven on a 5km journey with the ‘spare key’.
Various previous insurance claims were discovered that had not been previously mentioned.
Based on the information obtained during the investigation the insurer denied the claim. On the insured being advised that the claim was declined the insured asked for the return of the keys, which were returned. Shortly after the keys were returned the vehicle was located parked on a quiet residential street.
(L-R) Mathew McKee with Andrew Simpson (Polonious)
2014 Insurance Investigation of the Year
Sponsors by Polonious
2013 Insurance Investigation of the Year
Sponsored by Robert William Lawyers
The next cab off the rank for the awards announcement was the Insurance Industry Investigation of the Year, sponsored for the first time by William Roberts Lawyers. The Insurance Industry Investigation of the Year award is always one of the most hotly contested categories, with only 3 points out of a possible 75 dividing the top 3 nominees.
Mr Robert Ishak, partner at William Roberts Lawyers, announced the winner who had received the highest score from the judging panel, made up of Mr Ishak, Mr Laurie Ratz of the Insurance Fraud Bureau of Australia, and Mr Tony Phillips of RAA Insurance. This years award winner was named as Ms Jennie Hayes of Suncorp Insurance, for her co-ordination of a multi-claim investigation into an organised network of fraudulent claims.
Based on a tip-off, Ms Hayes oversaw a comprehensive investigation in which it was discovered that hired trucks were being used to cause total loss claims to vehicles that had been purchased in a damaged condition in one state and transferred to another state, before being placed in a claim to obtain a sum insured payout. Ms Hayes demonstrated tenacity in her pursuit of information, systematically contacting every truck hire company in the region to find the evidence she needed to find out the true facts of a current claim, but she also demonstrated an ability to strategically manage a large quantity of intelligence and to liaise with other stakeholders in order to submit a solid referral to the Fraud Squad in the state where the crime had been committed.
Despite being surprised on the night at being named the winner, Ms Hayes made a gracious speech in accepting her award and was a credit to her company.
Insurance Industry Award Winner Jennie Hayes Suncorp Insurance with award sponsor Mr Robert Ishak, partner at William Roberts Lawyers.
2012 Insurance Investigation of the Year
The award category for the Insurance Industry Auto Theft Investigation of the Year Award was one of the most highly contested categories this year, with only one point out of a possible
total of ninety points separating the winner and runner-up.
The well-deserving winner was Ms Jenny Caldwell of Western Australia. Jenny was instructed by her client to investigate the circumstances of a motor vehicle theft claim, where the Insured vehicle had been discovered stolen one morning after the Insured had been drinking heavily the night before.
The Insured spun an intricate tale of her attendance at a party leading to a romantic encounter with a stranger, before carrying on the party at her friend’s house and passing out on the lounge. In the morning, she woke up, and went to leave around 9am - to her horror she discovered that the car and the car keys were missing. She reported it stolen straightaway. In the meantime, the car had been recovered by the Fire Brigade, damaged and burned out, around 7.40am.
The breaking point for the Insured was when Jenny asked her to explain how her phone records showed her mobile phone being used in the vicinity of the recovery site about 20 minutes before the Fire Brigade were notified of the fire…when she was meant to have been asleep at her friend’s house over 20km away!
At this point, the Insured made the wise decision of admitting to Jenny that the theft had been staged by her friends, who had borrowed the car and crashed it whilst drunk and unlicensed, and that she had agreed to go along with the story.
Through great interviewing skills; methodical follow up on all leads and available documents; and application of innovative techniques, Jenny received an outstanding result – not only giving her client sufficient evidence to reject a fraudulent motor vehicle theft claim, but also to obtain restitution for their investigation costs!
Many thanks to the judges who helped determine the winner of the year’s Investigation of the Year – Paul Angus (Partner, Turks Legal); Mark Rix (General Motor Manager, Claims Services Australia) and Laurie Ratz (Special Risks Manager Insurance Council of Australia & Insurance Fraud Bureau of Australia).
Jenny Caldwell receiving her 2012 Insurance Investigation of the Year award from Australasian Branch President Mark Bennedick
2011 Insurance Industry Investigation of the Year
Winner: Insurance Investigator Jason Ostrofski
This year’s winning nomination in this category related to the reported theft of a 1995 Holden “VR” Commodore HSV enhanced “SS” V8 sedan. The version of events surrounding the
reported theft of the insured vehicle included the Insured attending a local service station on the evening of 24 April 2009 and returning home and then retiring to bed. It was alleged
that during the night the insured vehicle was stolen from the driveway in front of their residence. The vehicle was later located by Police just after midnight on 25 April 2009 approximately fifty kilometres south of the residence, completely destroyed by fire.
The Insured had a prior stolen motor vehicle claim ten months prior to the reported theft. Due to this the file was allocated to an investigator. Both the Insured and the Co-Insured (Insured’s wife), who were interviewed separately, were adamant that they had retired to bed by about 10:30 pm, after the Insured had returned home from the local service station.
A Forensic Locksmith was engaged to inspect the insured vehicle. The examination revealed that at the time of the fire the ignition system to the vehicle was still in place and the locksmith’s opinion was that the vehicle had been last driven with a correctly coded key. It was noted by the Forensic Locksmith that the insured vehicle a VR model Holden Commodore, came with an additional built in security system in that if a donor immobiliser system had been used that it had a forty-five (45) minute “time-out” feature whereby the vehicle could not be started.
The Insured had stated that he had attended the Caltex service station at about 10:00pm and was then in bed by about 10:30pm. The Investigator attended the Caltex and on searching the CCTV observed the insured vehicle and the Insured at the Caltex service station at 11:36pm. A copy of the Fire Report indicated that the Rural Fire Brigade had first been notified at 12:38am the next morning.
The investigator travelled to the incident scene. He recorded the kilometres and the time to drive to the location, which was in a remote bushland area. He was able to identify that the vehicle had crashed at the scene twice and then set on fire.
It was established that the offenders would have been with the insured vehicle for at least ten (10) minutes prior to being able to have started it, combined with the forty-five (45) minute “timeout” fitted to the vehicle. The Insured’s husband was at the Caltex in the insured vehicle at 11.36 pm which means that there was not enough time for him to have travelled home, locked the vehicle, and then had the offenders wait the forty-five (45) minute “timeout” and then drive to the incident scene which was half an hour away.
As a result of the evidence obtained during the investigation the insurer declined the Insured’s claim alleging fraud and the investigation file was handed to Police.
L-R: Jason Ostrofski and Suncorp Insurance, Acting Executive Manager Mr Chris Loane
2010 Insurance Industry Investigation of the Year
Winner: Insurance Investigator Karen Suljic
This year’s winner was nominated for an investigation conducted into the theft of two motor vehicles, a Ford F250 and a Mitsubishi Magna. The Insured in this instance lodged three claims. A household break in resulting in a burglary and the theft of the two motor vehicles. The investigator separated each claim and treated each claim on its own merit. This assisted the investigator to confirm whether the theft was related to the property or the motor vehicles.
As a result the following was established;
- There was minimal disturbance to the house and minimal property taken. A view was formed that the disturbance to the house was to assume the appearance of a theft incident. Therefore it was concluded that the incident was about the cars not the house.
- The F250 was purchased damaged for $11,000.00 from wreckers and the Insured was unable to prove it had been repaired. Further the Insured informed the insurer that he paid $65,000.00 for the vehicle.
- The Magna had significant mechanical issues and had previously been advertised for sale.
- The Magna was recovered burnt out and the investigator was able to locate vehicle parts in the boot of the magna. These parts were later identified as belonging to the F250.
- The recovery location of the Magna was in a rural property which had a fenced yard and padlocked gate. No damage was evident to the fence or padlock; therefore an opinion was formed that a key was used to access the property.
- The Insured flat mate’s movements on the day of the theft were inconsistent and telephone records reinforced the inconsistencies
As a result of this investigation the insurer, IAG, was able to deny the claim which was valued at $78,000.00. The Insured has not disputed this decision through the Financial Ombudsman or the courts.
L - R: Insurance Investigator Karen Suljic receives her award from Suncorp Insurance’s Executive Manager, Mr Jason McCracken, during the awards dinner
2009 Insurance Investigation of the Year.
This award recognises individuals working in the insurance industry that are involved in the investigation of auto theft insurance claims. The winner of the insurance investigation of the year award was Jason Ostrofski of Verifact Investigations Pty Ltd.
Jason was nominated for an investigation he conducted in 2008 into a claim for a stolen 2004 Toyota Corolla Hatch. Upon obtaining detailed versions from the policyholders and other relevant witnesses at the time of the alleged theft was able to -
- Locate witnesses at the recovery scene that provided relevant information to cast doubt over the policyholders’ version of events.
- Obtain lawful information from outside organisations that again added doubt to the policyholders’ version.
- Liaise with IAATI members to obtain advice on the security features for this model
After obtaining all this information he was able to formally discuss these concerns with the policyholders. As a result of the overwhelming evidence presented to the insurer the claim was declined.
Australasian Branch Vice President and Chair of the 2009 Awards Committee, Harry Rakintzis presents the 2009 Insurance Investigation Award to Jason Ostrofski.
2008 Insurance Industry Investigation of the Year Award
Winner: Jason Ostrofski, Verifact Risk and Investigation
On 3 July 2007, Verifact was sent instructions in relation to a Full Motor Vehicle Theft Investigation that was required to be carried out on behalf of an insurance company. The insured vehicle in this matter was a 2000 Kia Sportage station wagon.
The insured vehicle was allegedly left in an area of Brisbane on the evening of 30 June 2007, as a result of a mechanical issue by the Insured’s ex-wife. When she returned to collect the vehicle the following day it was found to have been moved from its original position, hence the alleged stolen vehicle investigation, and that it had been completely destroyed by fire.
The file was allocated to Jason Ostrofski due to his lengthy experience in motor vehicle theft and arson investigations.
Circumstances of Claim
It was It was alleged that the Kia Sportage suffered some kind of mechanical failure whilst being driven by the Insured’s ex-wife in a partially remote bushland area located in close proximity to her residence whilst she was allegedly travelling to a service station to purchase petrol for the vehicle.
It was alleged that the vehicle suffered a malfunction at about 8.30 pm on the evening of 30 June 2007. the Insured’s ex-wife claimed that she remained with the vehicle for a period of approximately 45 minutes, allegedly waiting for the malfunction to be corrected, which at that stage was alleged to have possibly been a fuel issue.
It was alleged that the insured vehicle was left at this location by the Insured’s ex-wife at about 9:15pm where she walked home, a distance of approximately 1.5 kilometres. She further alleged that she remained at home for the evening alone and retired to bed at about 11:15pm, where she slept through the night.
The Police Report into the matter indicated that the vehicle was located on fire at about 1:55am on 1 July 2007. Due to the vehicle having been extensively damaged by fire it was unable to be identified by Police at that point in time, and no owner was able to be identified.
On the morning of 1 July 2008, the Insured’s ex-wife returned to the area where she had left the insured vehicle the prior evening to find that it had been moved to a location further along the road where she subsequently found the vehicle completely destroyed by fire.
The Insured’s ex-wife then contacted Police and reported the insured vehicle stolen and destroyed by fire. No further investigations were conducted by Police at that point in time.
The Insured was an educated person who provided a plausible version of events regarding his movements around the time of the alleged theft and subsequent arson of the insured vehicle. Mr Ostrofski conducted a formal recorded record of interview in question and answer format with the Insured.
Mr Ostrofski used innovative interview techniques by utilising phases of the cognitive interview and conversation management models, allowing the Insured to provide his own account, confirming the Insured’s version of events by using probing questions and creating a detailed timeline of the period prior to and after the reported theft. The recorded record of interview locked the Insured into a detailed version of events.
The Insured had alleged that he flew out of Brisbane several days prior to the reported theft of the Insured vehicle and that he was working in the general Sydney area when the incident is alleged to have occurred. During the interview with the Insured Mr Ostrofski confirmed that the Insured was adamant that he was in Sydney at the time the incident is alleged to have occurred, which he did.
The Insured’s ex-wife was also interviewed by Mr Ostrofski in the same manner as the Insured was interviewed. Mr Ostrofski again used the cognitive interview models and probing questions allowing for a detailed timeline to be established prior to and after the alleged theft of the insured vehicle.
During the interview Mr Ostrofski specifically questioned the Insured’s ex-wife about the use of her mobile telephone and calls made during the period surrounding the alleged theft. Detailed questions were asked in relation to the time she retired to bed and whether she woke or spoke to any person throughout the night.
During the interview the Insured’s ex-wife stated that the insured vehicle had been suffering from a mechanical issue for an extended period of time prior to the incident occurring, which she stated that she believed was a fuel related issue. She stated that the insured vehicle had been previously towed by the RACQ break down service in relation to this particular mechanical issue.
At the conclusion of the interview Mr Ostrofski obtained a signed Authority from the Insured’s ex-wife allowing RACQ Break Down service to provide him with information with regards to their prior attendance on the insured vehicle, including previous dates of their attendance and results of mechanical issues with the vehicle.
After this authority was signed the Insured’s ex-wife made a final comment that on the day prior to the alleged theft of the insured vehicle, the insured vehicle had been towed by RACQ break down service from her daughter’s house back to her (exwife’s) house as a result of a flat tyre.
During the interview with the Insured’s ex-wife she stated that several hours prior to her driving the insured vehicle she had attended at a local service station where she filled a 5 litre petrol can with petrol which she claimed to have added to the insured vehicle thinking that it could have run out of petrol.
Mr Ostrofski then conducted enquiries at the local service station where the Insured’s ex-wife claimed to have purchased a can of petrol for the vehicle. As a result of this enquiry video surveillance footage of the Insured’s ex-wife was obtained of her filling a particular type of petrol can at the service station. A copy of this surveillance footage was taken into custody by Mr Ostrofski.
Mr Ostrofski then conducted enquiries with RACQ Break Down with the Authority that had been supplied by the Insured’s ex-wife. These inquiries revealed that an RACQ sub-contractor had in fact towed the insured vehicle on the day prior to the alleged theft of the vehicle. RACQ’s file notes in relation to the matter indicated that it was not towed as a result of a tyre issue and that it was in fact towed as the engine was unable to be started and was in-operable.
This information was then conveyed to our Client who then made arrangements to have a mechanical engineer carry out an inspection of the engine in the insured vehicle.
Mr Ostrofski then conducted enquiries with the Manager of the Towing Company who had towed the insured vehicle the day prior to the alleged theft. The Manager stated that he had spoken to his employee who had actually towed the insured vehicle and that his recollection of the mechanical issue with the vehicle was that it was unable to be started or driven due to the engine being seized.
Mr Ostrofski then attempted to obtain a signed statement from this employee and he stated that he did not want to get involved in the matter as he was worried about possible repercussions from the persons at the residence where he had towed the vehicle from, which was the daughter of the Insured’s ex-wife and her associates.
Mr Ostrofski then conducted enquiries with the neighbours of the persons from where the insured vehicle was towed from the day prior to the alleged theft. Neighbours were unable to provide any information about the insured vehicle. They did however provide information that the Insured’s ex-wife’s daughter had moved from the residence as the Police had allegedly located and seized a number of other stolen vehicles from the residence.
Inspection of Insured Vehicle
During an inspection of the insured vehicle a 5 litre fuel can was located in the rear of the vehicle which was similar in size and shape to that which had been used by the Insured’s ex-wife to purchase petrol on the night of the alleged theft, as indicated by the surveillance footage obtained by Mr Ostrofski.
Mechanical Engineers Report
The Mechanical Engineers who inspected the engine of the insured vehicle found that the engine was seized to an extent and that the crankshaft of the vehicle was unable to be turned, even with two (2) persons applying force with a large extended metal bar. Engineers stated that as a result of their inspection they were able to determine that the engine of the insured vehicle was seized prior to the fire which destroyed the vehicle.
Engineers stated that due to the engine in the insured vehicle having been seized that it would not have been possible for it to have been driven to the alleged theft site as claimed by the Insured’s ex-wife. Engineers were able to provide mechanical and scientific evidence to our client to confirm that the engine in the insured vehicle was seized prior to the alleged theft and subsequent fire in the vehicle.
Both the Insured and the Insured’s ex-wife supplied copies of their home and mobile telephone records, after numerous requests made by both Mr Ostrofski and the Insurer. The records were eventually supplied to us after several months.
The Insured’s mobile telephone records placed him around the Archerfield Airport in Brisbane on the weekend of 30 June and 1 July 2007, which contradicted his initial version that he was working in Sydney when the theft allegedly occurred.
The Insured’s ex-wife’s mobile telephone records indicated numerous calls to her daughter and a male person which was later identified as being her partner, between the hours of 12:00 midnight and 2:00am on 1 July 2007.
These calls were made when the Insured’s ex-wife claimed to have been at home asleep and also around the time when it is expected that the insured vehicle was allegedly stolen by being moved and then subsequently set on fire and then located by Police and the Fire Service whilst it was on fire.
Our client then requested that Mr Ostrofski re-interview both the Insured and his ex-wife in relation to the issue of the Insured’s whereabouts at the time of the alleged theft, the purpose of the calls made by his ex-wife when she claimed to have been asleep, and most importantly to address the issue of the insured vehicles engine being seized prior to its alleged theft and subsequent arson. Upon Mr Ostrofski requesting both the Insured and his ex-wife be re-interviewed, both persons declined to take part in an interview. The insurance company then declined the Insured’s claim alleging fraud.
The complete file, including the detailed records of interview conducted with the Insured and his ex-wife, the Mechanical Engineers Report and the home and mobile telephone records, have now been supplied to the Queensland Police Criminal Investigation Branch for their further investigation into the matter to determine if there is sufficient evidence to have the Insured and/or his ex-wife charged with Fraud related offences. That matter has not yet been finalised. Both the Insured and his ex-wife are currently in the process of utilising the Insurer’s Internal Dispute Resolution (IDR) Process in attempt to have the decision to reject the claim overturned. At this stage the Insurer has maintained their original decision to maintain the rejection of the claim alleging Fraud.
Throughout the investigation the Insured’s ex-wife made numerous complaints about Mr Ostrofski to both the Insurer and to Verifact with regards to a number of issues ranging from the type of questions that she was asked to the delays in the investigation process.
All complaints were investigated by both the Insurer and Management at Verifact and were found to be frivolous and vexatious in nature and no action was taken by the Insurer or Verifact against Mr Ostrofski.
Throughout the investigation Mr Ostrofski endured repeated verbal and physical harassment by the Insured’s ex-wife. The Insured’s ex-wife also made physical threats of violence towards Mr Ostrofski in the event that the claim was not paid by her Insurer.
Mr Ostrofski maintained a professional manner and attitude throughout the course of this investigation which ultimately lead to the Insured’s claim being rejected and allowing the Insurer to allege that fraud had occurred.
The investigation was detailed to Verifact as a Full Motor Vehicle Theft Investigation given that the insured vehicle was allegedly removed from the area where the Insured’s wife had originally left the vehicle and then later set on fire.
The claim was considered to have been a stolen motor vehicle claim which then allowed the Insured’s wife to receive a hire car from the Insurer for a period of 14 days due to the fact that the vehicle was allegedly stolen prior to being set on fire. The Insurer is also now considering attempting to recover the costs incurred by them for the supply of the hire car to the Insured’s ex-wife.
Although this claim is of moderate value, Mr Ostrofski has committed himself to conducting a detailed investigation of the claim regardless of the value of the insured vehicle.
- The investigation was conducted within the Insurer’s specified timeframe and in accordance with their service level agreement.
- The Insurer accepted all Mr Ostrofski’s recommendations during the course of the investigations.
- As a result of the evidence obtained during the investigation the Insurer declined the Insured’s claim alleging fraud.
- The Insurer was able to decline a claim in the vicinity of $10,000.00 plus claim that it had been fraudulently lodged.
The investigation was conducted with an exceptional level of knowledge, and professionalism. Mr Ostrofski has displayed innovative interview techniques, utilized the services of industry professionals and explored all avenues of inquiries including inquiries with external agencies during the investigation which provided an excellent result for the Insurer.
Jason Ostrofski, 2008 Insurance Investigation of the Year Award winner