Harold Nester

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Harold Nester began his career in law enforcement and after 17 years in that field found a second home in insurance fraud investigations. After several years conducting investigations in the Life, Health, Property and Causality areas in the United States, he began to travel abroad exclusively for 9 years conducting fraud investigations in the fields of life, disability, accidental death and medical insurance for most of the largest insurance companies in the United States. These claim investigations took him to many countries in Europe, Asia, the Mediterranean, Africa, the Middle East, Mexico, Central America and the Caribbean (with over 50 trips to Haiti). Harold has been a member of The World Association of Detectives since 2009.He has provided SIU training and given presentations on Foreign claim Investigations to insurance companies, reinsurance companies and professional groups across the United States.

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(Also known as United States Department of State Form Number DS 2060)
By Harold E. Nester Worldwide Resources Inc. Insurance Claim Investigations

Recently we have been assisting a life insurance company in processing a death of a Green Card Holder who left the United States on a pleasure trip to his country of birth. While in that country, the Philippines, he died a natural death.

We have for several years now, taken notice of a change the U.S. Department of State made to one of their forms. The form that I speak of is titled, Report of “Death of a U.S. Citizen or U.S. Non-Citizen National Abroad”. Originally this form was titled “Report of the Death of an American Citizen Abroad” Both of these forms are numbered DS 2060. An extension is added to the form number for revisions.

The form Labeled “Report of the Death of an American Citizen Abroad” was used when a United States Citizen died in an area outside of the United States or its territories. We have seen many of these documents cross our desks while in the process of completing insurance claim investigations and as you can imagine this new form “Report of Death of a U.S. Citizen or U.S. Non-Citizen National Abroad” was noted immediately. We suspect this form was slowly introduced by the Department of State, or just as previous forms became depleted in the Consulates around the world.
When we noticed the new form, we contacted a Consulate that we have worked with on a regular basis in completing verification investigations and learned that Green Card holders were being included with U.S. Citizens as being entitled to this service. We then accepted this as the new practice and new law.

Let me provide some definitions of terms at this point:

  • A Foreign National is a person who is not a citizen of the host country in which he or she is residing or temporarily sojourning. Example, a Foreign National in the United States is someone who is neither a citizen of the U.S. nor a Permanent Resident of the United States.
  • A Green Card Holder, common terminology, is a Foreign National who has been granted the status of a Permanent Resident of the United States.
  • A Non-Citizen National is an individual who was born in American Samoa or Swains Island only. Some consider the term Non-Citizen National a Historical Anomaly. Citizens of the Philippines had this status until at least 1934. Unlike Puerto Rico and Guam, the United States never intended to keep the Philippines, at the time of the Treaty of Paris, as a territory. As defined by the United States Department of State, A Non-Citizen National under U.S. law is neither a citizen nor an alien but one who owes permanent loyalty to the United States.

As originally stated in this writing, the case being worked in the Philippines became the beginning of our learning the true purpose of this form. Relatives of the deceased stated that they had approached the U.S. Consulate in Manila in an attempt to report the death of their relative, who was a green card holder in the United States. The family was told by the Consulate that “Death of a U.S. Citizen or U.S. Non-Citizen National Abroad” was not completed for Green Card holders. Our customer reported this to us, and we began an inquiry with the Department of State. After several hours on the telephone with various offices at the U.S. Department of State, we have learned the true intent of this form and the reason for its revision. This form, per Department of State Officials at the office of Overseas Citizens Services, was created for the use of the State Department, specifically for deaths of those who are Non-Citizen Nationals.

This document “Report of Death of a U.S. Citizen or U.S. Non-Citizen National Abroad” was created by our government, for the 54,194 residents of American Samoa and the 17, yes 17 residents of Swains Island. Officials insist that the Consulates that are using this form to report Permanent Residents, (or Green Card Holders) deaths are using it improperly. The U.S. Department of State has no form or responsibility for reporting the deaths of Permanent Residents who die outside the United States or its Territories.

When receiving these forms a proof of death they must never be relied upon as proof positive, but only as part of the verification of the death during the investigation. They must always be verified with the U.S. Department of State. Websites exist where it is possible to fraudulently complete and print this form with any identification information someone may choose to enter.

If you have questions about this topic or any issue involving foreign or contestable claim investigations, please feel free to contact us at the number provided here or on our website at:
www.worldwideresourcesinc.com

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insurance investigator

Based on recent surveys, property fraud reached $34 billion per year between 2011 and 2015. Healthcare fraud alone reached $259 billion in the year of 2010

Fraudulent insurance claims are reaching all time highs as people fake insurance claims. Fraudulent claims can range anywhere from forging dates on a claim form to faking an injury.

Thankfully, there are insurance investigators who look into these claims to ensure they’re legitimate. But how?

Read on to learn how an insurance investigator inspects insurance claims to fight fraud.

An insurance investigator will look at your past claims

An insurance investigator will go through your past claims to look for any red flags. They will take a look at how often you file claims and the nature of the claims. 

Insurance investigators will also look for patterns to see whether or not specific people have more probability than others to commit fraud.

They use data analysis to track patterns for all of their customers. So any red flags will be picked up immediately.

They check off a list of suspicious loss signals

There is a list of suspicious loss indicators that was created by the The National Insurance Crime Bureau (NICB). In fact, in 2013 the NICB released a press release stating that they have noticed a 26% rise in questionable claims since 2010.

When insurance investigators look at claims, they take a look at this list to make sure there’s nothing questionable about the claim.

Some of these indicators include:

  • Handwritten receipts when a repair has been done in damaged property
  • An increase in home or auto insurance immediately prior to a submitted claim
  • Significant financial debt on behalf of the claimant
  • Lack of police reports after the supposed accident

While these indicators do not always prove fraud, they do force investigators to look deeper into the claim.

They look to computers for help

Thanks to technology, computer software exists to detect fraudulent billing and charges.

Investigators use this software to pull billing records for fraudulent activity. And it doesn’t matter the insurance type. The computers use data and trends to investigate the legitimacy of the claims. For claims such as health claims, these computer software programs look for multiple surgeries on one claim for the same body part. 

But they can ultimately detect any fraud on any type of insurance, including auto insurance.

They’ll look at social media

Not all insurances will take a look at your social media pages. But if they suspect suspicious claims, they will take to social media for more information.

They will do a little digging to see if the claimant is in fact injured, or if their home is truly damaged. Social media often gives them the information they otherwise may not have found elsewhere.

Conclusion

As the statistics show, fraud is becoming prevalent across all insurance industries. From home to life insurance, investigators are taking a closer look at the claims that come through.

While most claims are legitimate, it’s always in their best interest to take a second look at suspicious claims. 

If you’re in need of insurance investigators for your firm, contact us for more information. 

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life insurance fraud

Murder plots and faking one’s own death in order to collect insurance money might make for juicy headlines, but they’re just a small part of the overall damage caused by life insurance fraud.

It’s difficult to get a precise figure, but the annual cost of life insurance fraud to insurers is “in the billions,” according to Coalition Against Insurance Fraud communications director Jim Quiggle. “Many instances of fraud are stealth scams. Nobody knows they happened.”

Indeed, not all types of fraud are sensational. The bulk of scams are rather tame and are sometimes perpetrated by insurance agents themselves. Put it all together, however, and the losses pile up.

Here are five ways people attempt to commit life insurance fraud.

1. Faked deaths

Everybody loves a good faked death story. Fascinating as these scams might be, they’re not common. They’re also extremely difficult to pull off.

Faked death schemes are cooked up not only to collect on the insurance of a person who’s still living but sometimes for somebody who never existed at all.

Take this story out of New Jersey, in which a man was charged after trying to collect on a policy after the death of an acquaintance. “This defendant allegedly took out a sham life insurance policy in the name of a stranger, then spent years just waiting for someone to die so he could cash it in,” said state Attorney General Christopher S. Porrino.

2. Premeditated murders

If you’ve ever seen the movie Double Indemnity, you know what we’re talking about. The film noir classic depicts a wife who plots with an insurance agent to kill her husband for a big payout.

“A combustible combination of greed, large dollar payoffs, and resentment can lead to a murder of a spouse or close family relation,” Quiggle said. “Many of the perpetrators think this is an easy crime to get away with.”

It’s not.

3. Forgery

While it’s not as sexy as a faked death or murder plot, most insurance scams involve simple forgery, according to supervisory special agent Joshua Tison of the insurance fraud section of the Pennsylvania Office of Attorney General.

A common example is somebody who is not the policyholder taking control and changing the beneficiary by “nefarious means,” he said. “That’s the bulk of the fraud we see.”

4. Pocketed premiums

This sort of scam can occur if an insurance agent tells you to make the checks meant to pay for your policy out to him instead of the company. In the end, your policy gets canceled due to lack of payment and your money rests in the agent’s pocket.

5. Policy upselling

An unethical agent may try to sell you a “better” or “upgraded” insurance policy. If you’re not careful, what you may end up doing is replacing a perfectly good contract with a new one that offers no extras and pays the agent a much higher commission.

Protect yourself from life insurance fraud

A few tips to make things more difficult for scammers:

  • Be careful who you turn your policy over to, demand paperwork for how money might be set aside
  • Check your agent’s license with the state insurance commissioner
  • Save all paperwork for the policy, including forms filled out by an agent
  • Don’t sign any paperwork with blank spaces that could be filled later
  • Read and make sure you understand a policy before you sign it
  • It’s okay to say “no” if you feel pressured into a sale

Got any more tips or stories about fraud? Leave a comment below or drop us a line.

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