Am I being defrauded by my insurance company?

January 26, 2017 2:06 PM

Got some strange emails from my insurance agent alleging I filed a claim for theft. I filed no such claim.

I inherited a house when my father died in 2009. Off and on for the past several years, we have had two renters. At other times, the house has been vacant. Currently, my grandpa is living in the house (rent-free), but the house is in my name and I pay the insurance.

Yesterday, I receive an email from Nationwide stating that my premium was going up by $150. The email stated that "we received a notice yesterday that the policy had been amended to reflect one claim from [two years ago]. This resulted in an increase on the policy due to the loss of the claim free discount."

I was incredibly confused. I was never informed of such claim and inquired further.

The agent said that it was a claim filed for $5,000 for theft by the "tenant."

I express my shock to the agent and request yet more information. Already, this is sounding incredibly fishy. My grandfather never filed a claim, I never filed a claim. I immediately begin to think fraud.

After much back and forth, the agent tells me that they have no further details on the claim because they don't "look at all of the details of the claim unless we call and question." She told me to "forget about it" and that since "the claim was filed by a tenant at the time of the loss, so this does NOT apply to you."

Huh?

As I read the situation, I feel like someone filed a claim and made off with $5,000. And the insurance company isn't even interested in investigating this?

My questions are:
1) Neither myself nor my grandpa filed any such claim for theft. The previous tenants were not the best tenants, but they also weren't the sharpest crayons in the box. I don't have much faith they could commit insurance fraud.

Is it possible that I'm being defrauded by the agency itself? That it's an "inside job"?

Can someone in the insurance world (or who knows about this stuff) lay out a plausible scenario for me?

I can't tell if I'm overreacting.

posted by Cwell to Work & Money (5 answers total)

Best answer: It sounds to me like a prior tenant made a renter's insurance claim for theft. This claim is tied to your address by a national insurance claim database. Your current insurance found this claim during a search and your insurance cost is affected by it.

I know when I sold my house, the fact that I had made some insurance claims prior to the sale affected the rate that my buyers could qualify for.
posted by muddgirl at 2:12 PM on January 26, 2017 [7 favorites]

Best answer: Skip your agent, who is likely a licensed broker, and call the main company. Find someone in a supervisor position. Ask them questions and ask for further documentation on the original claim.

Then...Write a follow-up letter and provide copies of all the documentation you have thus far. Get the supervisor's fax and fax this.

It could be a clerical error. It could be a tenant defrauded you in which case you have recourse. It could be the agent filed a fraudulently claim. WE DON'T KNOW.

You know who does know? The Insurer that paid on the claim. Call them and explain your situation. By-pass the agent on this issue.

PS - fire your agent who just told you "don't worry about it" when this is all cleared up. If they committed the fraud they will be facing charges and will be "fired" for you. Seriously, stop dealing with this broker. They are not professional, possibly worse.
posted by jbenben at 2:15 PM on January 26, 2017 [15 favorites]

Once you get to the bottom of this, you might report their "just forget it!" to your state insurance licensing board because - GEEZ!

UPON EDIT: muddgirl probably has it, but I think your agent should have explained this to you. follow-up.
posted by jbenben at 2:16 PM on January 26, 2017 [9 favorites]

I guess it's possible that your agent could have filed a fraudulent claim, but that seems unlikely to me. He'd lose his license, and, because commissions are paid on a constantly-recurring stream of renewal business, a significant source of income. For $5000? Not worth it.

Was your grandfather living in the house at the time of the alleged loss? Or were your previous tenants there?

Did you switch insurance companies since the alleged loss?

What type of policy is covering this property? Typically, rental properties are covered by dwelling fire policies, which only cover the structure of the building, and the tenant is responsible for renter's insurance to cover the contents. If you've got a DFIRE policy and the claim is for theft, I'd be very concerned.

I would get as much information about this claim as possible. As jbenben said, get it from the company directly, not your agent. Agents don't really do much with claims. If you ask your agent to get it, they'll just turn around and call the company, so cut out the middleman. The company should have a detailed record of who made the claim, what allegedly occurred, and any correspondence they sent/attempted to send to you. Once you have that, you'll have a better idea of what happened, and we can go from there.
posted by kevinbelt at 2:20 PM on January 26, 2017 [2 favorites]

Response by poster: Kevinbelt -- This is a dwelling/fire policy, yet another reason why I'm concerned. How could a theft claim even be filed on such a policy?
posted by Cwell at 2:23 PM on January 26, 2017 [1 favorite]