Slip and Fall Investigation Leads to Claimant’s Arrest
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 On January 26, 2022, Tammie Childs was arrested in Philadelphia County. According to the criminal complaint, Childs filed a lawsuit against 2 Brother’s Mini Market, in which she alleged that on June 8, 2019, she slipped and fell due to water that had pooled on the floor of the Philadelphia store. Childs allegedly claimed that the fall caused injuries to her right shoulder, left elbow, right wrist, and left lower back. The complaint stated two men who were in the store at the time attended to Childs and called an ambulance. However, Childs allegedly left the store before EMS arrived. According to the complaint, an investigation of the scene did not support Child’s claim that the store floor was wet at the time of the incident. The complaint further stated that Childs was observed walking with a significant limp before she entered the store. Moreover, investigators reviewed store video footage of the incident and allegedly determined that Childs’ actions prior to her fall suggested that the accident had been staged. According to the complaint, Childs’ medical records revealed that several days before the incident, Childs was transported by ambulance to a hospital and was diagnosed with a fractured patella. Investigators also allegedly found that between 2003 and 2019, Childs had filed multiple slip and fall claims for accidents which purportedly had occurred at local businesses. Childs was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), and once count of Insurance Fraud (M1).
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 On January 26, 2022, David Britton was arrested in Dauphin County. According to the criminal complaint, Britton filed a claim with the Pennsylvania Department of General Services, Financial Risk and Management Division, for damage to his vehicle caused by overspray from a PennDOT painting truck on May 11, 2021. In support of his claim, Britton allegedly provided two repair estimates to the Department of General Services totaling $1,350.00 and $1,300.00 respectively. Investigators contacted the businesses that had provided the written estimates to Britton. According to the complaint, the businesses maintained that they each had provided an estimate to Britton, which totaled $350.00 and $300.00 respectively. The complaint stated that investigators concluded that Britton had submitted altered estimates which reflected totals that were $1,000.00 higher than the actual estimated repair costs. The claim was denied. Britton was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), and one count of Criminal Use of Communication Facility (F3).
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 On January 24, 2022, Amanda Thomas was arrested in Chester County. According to the criminal complaint, on August 15, 2020, at approximately 10:00 PM, Thomas’s 2012 Ford Edge was involved in a three-vehicle accident. At 11:03 PM, Thomas allegedly contacted Progressive Insurance via the internet and purchased an insurance policy for her vehicle. The complaint stated that on August 16, Thomas used Progressive’s mobile system to report that she had been involved in an accident at 11:30 PM on August 15. However, a witness allegedly reported that when she encountered Thomas at 10:00 PM, Thomas admitted that her Ford accidently struck the witness’s parked car. A report filed by police allegedly revealed that officers responded to the accident scene at 10:59 PM and cleared the scene at 11:30 PM. According to the complaint, Progressive determined that Thomas’s policy was not in effect at the time of the accident. The claim was denied. Thomas was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), and one count of Criminal Use of Communication Facility (F3).
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 On January 13, 2022, Natalie Bishop was arrested in Erie County. According to the criminal complaint, Bishop allegedly reported to Nationwide Insurance that she lost her engagement / wedding ring. Bishop allegedly claimed that she noticed that the ring was missing from her dresser drawer several months earlier, and that she had been unable to find it. The complaint stated that Nationwide Insurance located a jewelry store receipt for the ring which was dated after Bishop allegedly had claimed that the ring went missing. According to the complaint, the store manager confirmed the date on the receipt. The manager allegedly advised that Bishop brought the ring in to the store for repairs and picked it up approximately a week later. Nationwide Insurance denied the claim. Bishop was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt / Theft by Deception (F3).
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 On January 5, 2022, Christine Forish was arrested in Westmoreland County. According to the criminal complaint, on August 26, 2021, a Nationwide-insured car owned by Forish’s mother rear-ended another vehicle. The owner of the other vehicle filed a claim for the accident with Nationwide. During a telephone interview, Forish allegedly told Nationwide that she had been driving her mother’s vehicle at the time of the accident. However, according to the complaint, the other driver maintained that the driver of the Forish vehicle was a male. Investigators allegedly determined that Forish’s boyfriend, who was an excluded driver on the Nationwide policy, had been driving Forish’s mother’s car at the time of the loss. According to the complaint, Nationwide received an email from Forish on September 1, 2021, in which she allegedly admitted that her boyfriend had been driving her mother’s car when the accident occurred. Nationwide did not pay the claim. Forish was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt / Theft by Deception (F3).
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 On January 3, 2022, Tyalif Grimes was arrested in Montgomery County. According to the criminal complaint, on May 3, 2020, Grimes was involved in a two-car accident which damaged both vehicles. On May 7, Grimes allegedly purchased coverage for his vehicle from Progressive Insurance. According to the complaint, Grimes submitted a claim to Progressive on June 25, for damage that his vehicle purportedly incurred from a June 22 deer strike. The complaint stated that Grimes acknowledged that his car had been involved in a previous accident on May 3, but insisted that the earlier loss resulted in only minor damage to his car’s front bumper. Grimes allegedly maintained that the June 22 deer strike substantially damaged his vehicle’s hood, headlight, and one of the side support columns. The complaint stated that Grimes submitted multiple photos of the damage to the insurer. The complaint further stated that unbeknownst to Grimes, the other involved vehicle from the May 3 accident was insured by Progressive, and the driver filed a claim with the insurer for that loss. The other driver also submitted photos to Progressive showing the damage to both vehicles. According to the complaint, Progressive adjusters compared photos from both sets of claims and determined that the damage to Grimes’ vehicle occurred during the May 3 accident, before Grimes purchased his Progressive policy. Progressive denied Grimes’ claim. Grimes was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), one count of Criminal Use of Communication Facility (F3), and one count of Unlawful Use of a Computer (F3).
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 On January 26, 2022, Michael Rodriguez was sentenced in Chester County after entering a negotiated plea to one count of Insurance Fraud (F3) and one count of Criminal Conspiracy (F3). Rodriguez was involved in a motor vehicle accident on January 4, 2020, at approximately 1:14 PM. At 5:52 PM, Rodriguez and his girlfriend went online and obtained a GEICO insurance policy for Rodriguez’s vehicle. Rodriguez contacted the insurer on January 5 at 10:09 AM and stated that his vehicle was involved in a crash that occurred at approximately 6:00 PM on January 4. Rodriguez and his girlfriend confirmed the 6:00 PM time of loss during subsequent interviews with investigators. However, the girlfriend allegedly admitted that she had purchased coverage for Rodriguez’s vehicle after the accident occurred and had claimed that the crash took place after the policy inception. Rodriguez was sentenced to a period of 6 to 12 months incarceration for the Insurance Fraud charge, followed by a year of probation. He was ordered to serve a concurrent term of 12 months of probation for the Criminal Conspiracy charge. Rodriguez’s girlfriend previously pled guilty and was sentenced on identical charges.
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 On January 25, 2022, Darlene Johnston was sentenced in Lawrence County after entering a negotiated plea to one count of Criminal Attempt / Theft by Deception (M1). On November 22, 2019, Johnston filed a claim with State Farm Insurance for damage to the front end of her 2014 Buick Enclave. A body shop inspected the damage and provided an estimate and photos to State Farm. The insurer issued a check to Johnston in the amount of $3,814.40. On December 8, 2020, Johnston filed a new claim with State Farm, wherein she reported that her Enclave incurred front end damage from a deer strike which occurred on November 19. A different body shop inspected the damage and provided photos and a written estimate to State Farm. The insurer compared both sets of photographs and estimates and determined that Johnston had claimed the earlier damage a second time. Johnston was sentenced to 12 months of probation. She was ordered to serve 50 hours of community service and to pay prosecution costs.
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 On January 7, 2022, Timothy Rush was sentenced in Snyder County after entering a negotiated plea to one count of Criminal Attempt / Theft by Deception (M1). Rush obtained coverage from Progressive Insurance for a camping trailer at approximately 5:33 PM on April 28, 2020. Rush subsequently filed a claim for damage to the trailer and advised the insurer that the loss had occurred on April 29 at approximately 11:15 AM. Rush submitted photos of the damage to Progressive in support of his claim. The metadata from the photos revealed that they had been taken on the afternoon of April 28, which was before Rush obtained the coverage from Progressive. An investigation confirmed that the trailer had been damaged prior to the policy inception. Rush was sentenced to serve 23 months of probation and was ordered to serve 25 hours of community service. He was fined $250.00 and ordered to pay all court costs.
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 On January 7, 2022, Ernest Wegg was sentenced in Warren County after entering a negotiated plea to one count of Insurance Fraud (F3). Wegg obtained a Progressive automobile insurance policy which took effect on February 3, 2018. On December 4, 2019, at approximately 5:43 PM, Wegg added comprehensive and collision coverage to the policy. On December 16, Wegg filed a claim with Progressive in which he reported that his vehicle was involved in an accident on December 15 and sustained front end damage. However, the police crash report revealed that the accident actually occurred on December 4, 2018, before Wegg’s coverage took effect. Progressive denied the claim. Wegg was sentenced to serve a period of 9 to 23 months of incarceration. He was ordered to serve 50 hours of community service and to pay prosecution costs.
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 On January 6, 2022, Jaison Kelly was sentenced in Allegheny County after entering a negotiated plea to two counts of Criminal Attempt / Theft by Deception (M1). The Pennsylvania Insurance Department received a complaint from State Farm Insurance concerning Kelly, who was employed as a State Farm agent between June 1, 2016, and April 13, 2018. An Insurance Department investigation and audit revealed that during his tenure as a licensed agent, Kelly submitted two fraudulent credit applications in his grandfather’s name to State Farm Bank. On September 14, 2017, Kelly submitted an application to refinance an $111,000.00 loan for a 2017 Maserati Levante. On December 4, 2017, Kelly submitted an application for $125,700.00 in credit to purchase a 2017 Thor Motor Coach Ace. When State Farm Bank requested verification of income, Kelly provided nothing in support of the first application, but submitted fabricated pay statements in support of the income listed on the second application. Kelly was sentenced to 23 months of intermediate punishment, the first month of which he was ordered to serve under house arrest. He was fined $2,500.00, and ordered to perform 100 hours of community service and to pay all court costs.
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During the month of January, six additional defendants received Accelerated Rehabilitative Disposition (ARD).
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Anti-Fraud Compliance - Reporting of insurance Fraud to Law Enforcement Agency
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Pennsylvania Bulletin Notice 2016-04 (issued April 30, 2016) reminded insurers of their obligations to report suspected arson or insurance fraud to law enforcement agencies within the Commonwealth. The bulletin also announced a decision by the Pennsylvania Department of Insurance to allow licensees to satisfy their reporting obligation when they electronically submit reports of suspected fraud to the National Insurance Crime Bureau (NICB).
On July 6, 2017, Pennsylvania began participating in this online service which enables member companies to electronically forward reports of suspected fraud to the Pennsylvania Office of Attorney General’s Insurance Fraud Section or other appropriate law enforcement agencies at the same time the companies report suspicious claims to the NICB. NOTE: The NICB is not a law enforcement agency. Therefore, a licensee cannot satisfy the fraud reporting requirement by submitting a non-electronic (paper) referral only to the NICB.
Important: When utilizing electronic filing through NICB, users should take careful note of the provided instructions regarding the “Party” to a claim. Information entered about a Party will only be transmitted to law enforcement if users select one of two options: “This Party was subject to an SIU investigation” or “This Party was subject to an enforcement action.” Some users have missed this notation about individual Party data and consequently have submitted incomplete information to law enforcement.
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