The IAATI Insurance Investigator of the Year Award

Nominations Deadline: May 01, 2018

All nominations should be sent to: .(JavaScript must be enabled to view this email address)

This award was created in 2014 in order to recognize and honor insurance professional (individual or group) for his or her outstanding contribution in the area of vehicle theft investigation or insurance fraud investigation.

For information on the judging criteria for this award and tips on how to apply please download the 2019 IAATI Insurance Investigator Award_How to nominate brochure at https://www.iaati.org/awards/insurance2019

Award Recipients

Year
Name or Group
2018
John Borland - ISACORP Limited

John Borland, ISACORP Ltd. (New Zealand) receiving the Insurance Investigator of the Year Award from President JD Hough and committee chair, Mark Pollard.

This nomination was submitted by:  Kristine Tempest, National Claims Manager Property & Marine, Commercial Claims, QBE Insurance, New Zealand.

Award Nomination – Senior Investigator John Borland
I am delighted to nominate Senior Investigator John Borland of ISACORP in the category of ‘Insurance Investigator of the Year’. This nomination is in recognition of professional and extensive investigative actions completed by John which successfully recovered three motor vehicles (valuing $291,200NZD) stolen in New Zealand and further identified parties culpable for the theft.

The nomination recognizes the ability of John in networking and fostering relationships with all interested parties and organizations associated with the claim which resulted in full recovery of the vehicles, identifying risk issues for the insured to prevent future loss, establishing third party liability of parties responsible for the theft and completing a comprehensive brief of evidence which provided evidence for the police to progress criminal proceedings against culprits. This nomination reflects John’s ability to plan and facilitate a detailed investigative operation, utilize innovative strategies and communicate on multi-levels with various professionals to ensure the investigation was successful.

Overview
On 26 July 2017, the claimant reported the alleged theft of the above mentioned vehicles from their secured compound located in the Auckland region. The claimant stated the three vehicles had been stolen on an unknown date between 1 March 2017 and 14 July 2017, the theft was identified only once a request was made for the vehicles to be distributed to another car dealership. Upon reviewing their fleet and job cards, the claimant confirmed the theft of the three vehicles, subsequently contacting the police and insurer notifying them of the theft. On 28 July, upon review of risk, I suggested to my claims handler to appoint John to conduct a full investigation in relation to this matter.

Preliminary Enquiries
During preliminary enquiries, John completed a full review of the claimant policy and insurance history ensuring that our client had no fraud or risk indicators. His efforts were then immediately drawn to ascertaining points of entry for the theft, CCTV avenues and scene examinations. I recall being impressed by his urgency with regards to establishing critical CCTV before it was lost due to time lapse. John’s initial enquiries included the following:

  • Scene examination – establishing possible points of entry/exit due to poor CCTV coverage.
  • CCTV gathering – Identifying businesses in the area to obtain CCTV for suspect identification and direction of travel for stolen vehicles.
  • Policy & History Review – Establishing claims legitimacy from the insured to negate fraud suspicion.
  • Operation Order – Develop an operation order and action plan for the overall investigation

Initial Record of Interview
Given the profile of the claimant, I was impressed with the professional yet resolute approach John undertook when interviewing the claimant and broker. John successfully completed a detailed record of interview with insured, confirming there was no fraud, inflation or suspicion on the claimant’s behalf. Furthermore, John’s interview established new points of contact within the insured company to further investigative and relevant persons to interview.

John was able to determine vital points of the insurance claim which were previously unknown which included; an approximate time of loss, security records for entry/exit points, company CCTV footage which could be reviewed and potential witnesses to the theft.

Contact with Police
Following on from the interview John personally attended the relevant police station and had a meeting with the investigating officer. John was able to efficiently communicate with the officer successfully gaining priority of the investigation – this is particularly impressive as often assistance from the Police is very limited due to their work schedule. A ‘cross-operation’ was agreed to and John provided the officer with all businesses and intersections which had CCTV which the police attended and seized. The police agreed to complete the investigations pertaining to the direction of travel of the vehicles whilst John focused on the internal aspects of the claimants company. I am aware they held briefings regularly throughout the investigation and to date I believe the overall investigation benefited from this rapport building by John.

Investigative Strategies

CCTV
After the interview with the claimant and the Police, John commenced the body of his investigative operation. I recall he held meetings with a number of staff from the claimants company, establishing their integrity before delegating roles for them to complete which would expedite the investigation. John drew his attention to the CCTV from the company which he and a staff member reviewed for many hours. Together they reviewed all CCTV which covered a month and a half period – John with the assistance of the staff member identified that the theft took part on 6 July 2017.

Specifically the full CCTV review established:

  • The entry of two suspects who entered through the security gate at night behind a delivery truck.
  • The fifteen (15) minute period they were on the claimant’s property
  • Partial description of what they were wearing
  • The exit point where only 2 vehicles (BMW’s) were stolen

Upon observing only two vehicles were stolen at this time a further review was conducted of the claimants logistic records which identified the third vehicle (RAV4) was not stolen and had been placed in the wrong spot by an employee – immediately reducing the claim amount by approximately $35,000.00NZD.

After the CCTV was finalized John completed an examination of the site of loss, it was here he established vital information which allowed suspects to be identified. John identified the hangar from which the two motor vehicles were stolen had no signs of forced entry and it was confirmed the particular hangar roller doors were locked prior to the theft. John was adamant that persons responsible had to have had swipe keys to access for the hangar and would have unlocked the garage doors internally.

Witness Interviews
John then completed witness interviews with all contractors and staff identified on CCTV around the time of loss. Whilst this did not yield any information relevant to the investigation it emphasized the depth John goes to in ensuring all investigative avenues are covered.

Suspect Identification
John then briefed the claimant and appropriate staff with the view of reviewing the relevant CCTV to try and identify the suspects depicted. Through the use of investigative briefings John identified that an item of clothing that was worn matched that of a contracting company that frequents the claimant’s compound. John reviewed their staffing portfolio and established three (3) staff were rostered on by that company, suspect interviews were conducted with two (2) who provided accurate alibis. The final employee appeared to evade contact from John and the company owner – which resulted in John establishing that entity as a suspect in this matter.

Telco Strategies
I am aware that upon identifying this suspect, John completed another briefing with the investigating officer from the New Zealand Police. John requested that the officer complete a ‘ping’ on the suspects’ mobile devices to establish if he was at the site of loss when the theft occurred. Due to privacy reasons the results were never provided by the Police however it was established that the strategy had been ‘successfully completed’.

Third Party Liability Admission
At the request of the claimant, John allowed him to engage with the contractor with respects to providing the information discovered as a result of Johns investigation for comment. The owner of the company immediately agreed that the overwhelming body of evidence supported the fact that the theft was as a result of one of his employees and stated his company was potentially liable for the loss.

Location of Outstanding Motor Vehicles
Shortly after the interview between the claimant and the third party, the outstanding motor vehicles were located parked on the side of the road with minimal damage in a district north of the site of loss. The Police forensically examined the vehicles before relinquishing them to the claimant resulting in a physical recovery and return of $256,200.00NZD worth of luxury motor vehicles.

Claim Outcome
As stated above, the claim was completed by John utilizing various strategies implemented with planning and precision. All skills and strategies implemented abided by the written instructions, scope of expertise, the Fair Insurance Code and in accordance with the service level agreement relevant to all agencies involved. Of satisfaction was that the preferable outcome was achieved within timeframes dictated by industry codes and regulations. John ensured all parties were briefed where appropriate and ensured transparency at every stage of the investigation.

Overview
This investigation demonstrates John’s expert level of skill and experience in planning and executing complex investigations. His timely application of skills and strategies including; physical interviews, forensic examinations, police cultivation, suspect identification, telco strategies and CCTV examination resulted in a very successful outcome.
John should be commended for his attention to detail, adhering to legislation, demonstration of investigative skills and overall planning and implementation. It should be noted that the outcome of John’s investigation yielded a very positive result for QBE New Zealand and its shareholders. The detailed results subsequent to John’s investigation include:

  • Investigation completed and property returned within one month of instruction
  • Full recovery of three motor vehicles totaling a value of approximately $291,200NZD
  • Risk issues identified for claimant to prevent future loss
  • Third-party liability grounds determined for remaining recovery avenues
  • Comprehensive report and brief of evidence which police were able to utilize for any further criminal proceedings
  • Positive relationships fostered between a lucrative client and QBE New Zealand
2017
Francois Pienaar-SAICB
2017
Ivan Burger-SAICB
2017
Mervin Maynard-SAICB
2016
Inv. Tom Pruett North Carolina Dept. of Insurance and Rusty Russell, NICB

In May 2012 Investigator Tom Pruett of the North Carolina Department of Insurance, Criminal Investigations Division received a referral on an individual who had recently filed six insurance claims on the same all-terrain vehicle (ATV). NICB Special Agent Darrell “Rusty” Russell soon joined the investigation. Upon reviewing prior claims history of the involved subjects, a pattern of possible insurance fraud quickly emerged.

Investigators confirmed that damage claims had indeed been filed multiple times for the same ATV, even though one insurance company had, in fact, totaled the ATV. Ironically, the investigators learned that owner of the ATV and the owner of the repair facility were one in the same, and that owner just happened to retain the salvaged ATV. Upon recognizing the nexus to the repair facility, Investigators Pruett and Russell began to coordinate their efforts with Inspector Marc Epstein of the North Carolina Division of Motor Vehicles.

The ensuing investigation determined that the fraud scheme was more complex and involved a ring of individuals, spearheaded by the same individual who just happened to own the three repair facilities that were allegedly performing the repairs. The repair facilities were being operated from the same location. It was determined that the suspects were buying salvaged ATVs, then securing insurance policies and filing claims alleging that the ATVs were falsely damaged while off-roading. Initially investigators identified 21 insurance claims totaling $121,261.92, or an average of $5,774 per claim.

The thieves soon graduated from ATVs to custom-built motorcycles with an average of $14,000 per insurance claim. Interestingly, the ringleader was authorized by NHTSA and the NCDMV to manufacture custom motorcycles, and as such, had the ability to assign vehicle identification numbers and create Manufacture Statement of Origins. In the same manner, the ring would secure insurance policies on the motorcycles and then file claims alleging that the bikes were damaged. The thieves would often provide the MSOs as proof of ownership. This scheme netted the thieves $517,004.13 in insurance proceeds. This total did not include similar schemes involving antique cars, boats and campers.

During the next two years investigators requested, received and reviewed countless insurance files from multiple carriers. The investigation culminated with the arrests of 11 people in conjunction with 45 fraudulent insurance claims totalling $671,241.09. On September 9, 2015, ringleader Spencer Bowman plead guilty to 12 different criminal counts. Criminal charges against eight other individuals await final disposition in the court system. Charges against the remaining two persons were ultimately dismissed.

2015
Northwestern Massachusetts Insurance Fraud Task Force

The winners of the 2015 Investigator of the Year Award were a group of individuals who cooperated and worked tirelessly to bring to a successful conclusion, an investigation that lasted 2 years. It involved a network of people who, while living in New York City, had registered their vehicles in Massachusetts for the purposes of a lower insurance rate. After an initial investigation, the Insurance Fraud Bureau of Massachusetts was joined by the Northwestern District Attorney’s Office, who in turn solicited the assistance of the Massachusetts State Police, Department of Homeland Security and the New York City Police Department. As the result of this multi-agency collaboration, a total of 48 individuals were charged with over 300 counts of insurance fraud, perjury and conspiracy. This success was a direct result of the professionalism and dedication of the Task Force members who were collectively the winners of this year’s Insurance Investigator of the Year Award:

  • First Assistant District Attorney Steven E. Gagne, Northwestern District Attorney’s Office, Northampton, Massachusetts
  • Michael C. Cantwell, Lead Investigator, Western Mass Task Force, Insurance Fraud Bureau of Massachusetts (Case Investigator)
  • Matthew F. Markiewicz, Senior Investigator, Western Mass Task Force, Insurance Fraud Bureau of Massachusetts (Case Investigator)
  • Mark E. Hannigan, Senior Investigator, Brockton Task Force, Insurance Fraud Bureau of Massachusetts
  • Gregory M. Materas, Investigator, Insurance Fraud Bureau of Massachusetts
  • Lieutenant John Cummings, Massachusetts State Police
  • Trooper Corey Mackey, Massachusetts State Police
  • Sergeant Kevin Crimmins, New York Police Department, New York City, New York
  • Detective Patrick Donohue, New York Police Department, New York City, New York