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(Prime Time Crime exclusive Oct. 15, 2011)
Is Insurance Fraud Still Considered A Crime?
By Tom Span
Dire Straits isn’t just a very popular band from the 1970’s and onward. It is also a situation that one can be in when things do not go well. That goes for much of the private investigation industry and me as well at this time. The current situation we find ourselves in is no doubt partly due to the choices we have made, which for me at the time seemed reasonable under the circumstances. Today however, in relation to mine and all other Private Investigator businesses as it concerns the Insurance Corporation of British Columbia, which was traditionally, the major requester for PI services, things have occurred that are destructive and anything but reasonable. Unfortunately, I have no direct control over those things. But, I feel that I might have a minor influence, which is my reasoning for writing about this subject matter. Allow me to explain on behalf of myself while I also take the liberty to write on behalf of all other PIs who find themselves in the same predicament after making their individual choice to concentrate on doing contractor work on behalf of ICBC. Not knowing most of the other PIs personal backgrounds I am left to describe only my own. I do know however, that many PIs out there have a theme similar to mine within their adventure, albeit with varying plots so to speak. They, along with ICBC premium payers do not deserve the ramifications of ICBCs latest model of doing business, which includes little investigation of fraudsters and cheaters. Private Investigators, other service providers and rate payers are not car parts. We are people deserving of at least some measure of respect, which ICBC appears incapable of showing. After 24 years of providing service to ICBC as a contractor, I now seriously question why I started down that road in the first place. Perhaps a review is in order.
When I left the employ of the Vancouver City Police Department on February 02, 1987 after 12 years service I did so because I was very hurt and angry over a situation that led to what I believe was the preventable death of a fellow policeman. On that very day, Sgt. Larry Young of the VPD ERT Team was killed by a criminal named John Sheffield during what I believed and still do was an avoidable drug bust.
John Sheffield on January 06, 1987 slightly less than one month before he shot and killed Sgt. Larry Young had been in police custody for drug possession and also for being the prime suspect in a drug rip off situation within which he had filled another drug dealer full of lead. In fact, that man had sustained serious life threatening injuries. There were four .32 calibre rounds into his chest and one round into his face. Despite all that, that man survived that incident and did not co-operate with our police investigation by identifying the shooter who he knew. He had said to me at the time after I gave him a Dying Declaration on the spot, “I will deal with this myself.” The Dying Declaration amounted to me telling him that he was going to die so he should tell me who shot him and that I would then offer that evidence to the court and have it accepted if he had indeed accepted the fact that he was going to die. The Dying Declaration angle to court evidence admissibility is based on the notion that a dying man would not lie for any reason. I did not say that I agree with that. I simply stated that I offered that man an opportunity for some justice. To this day I am surprised that he did not succumb to his wounds at that time. But, I am not surprised that he was killed not long thereafter in another manner consequent to his actions in relation to the initial Sheffield shooting incident. He had tried to rip John Sheffield off for his drugs. Frontier Justice I believe it is called.
John Sheffield was on mandatory parole on January 06, 1987 while he was in possession of drugs and shot the drug dealer. In my mind, perhaps arguably, he should have been kept in custody, thus not be in a position to shoot and kill Sgt. Larry Young. But for reasons I choose to not get into within these particular writings, he was not. Thus, the situation led to the incident within which Sgt. Larry Young was killed and another policeman, Al Catley, was shot in the leg. There were other ramifications of the shootings. John Sheffield was shot and killed by ERT members and one of the ERT Team members thereafter took a very wrong turn in life leading him to serving life in prison for murder within subsequent circumstances.
When I first heard about Larry Young’s death, which was shortly after it occurred because I was telephoned almost immediately and advised of the incident by another policeman who was assigned to do the initial primary investigation, I was hurt by the tragedy and also became very angry. I was angry because I was not understood or simply not listened to when I had warned before John Sheffield’s release that he would kill a cop while the cops reel him back in later if he was let go. My immediate reaction to the situation was such that I said, “That’s it. I’ve had it. I’m done.” The same day I telephoned the on duty Corporal at the VPD Public Information counter and informed that I would not be back and I wasn’t.
Even before hearing of Sgt. Larry Young’s death, there were numerous other factors no doubt that had influenced my head space toward my discontinuance of being a policeman. Not the least of which was that I was there at the VPD Oakridge substation on the morning of December 17, 1986 only 47 days before Larry Young’s death. On that date, a fellow policeman and friend shot and killed himself in the washroom after being accused of an event that he was very likely not guilty of. Just minutes before he killed himself he had said to me, “Tarnished by the brush. I will never be able to get past this. It’s one person’s word against another. I’ll be charged because no-one in the department or the Crown wants to make a decision. So, they will leave it up to a judge. Hopefully that judge would find me Not Guilty, but the stigma will always be there.” A little later, as I stood by my friend laying on the gurney at Vancouver General Hospital and while I held his hand so that he would know I was there with him, I wondered, perhaps aloud, “Did I say the right things to my friend and should or could I have known what was about to happen and stop it?” The ER doctor interrupted my thought process by asking me, “What the hell are you doing? I answered, “I don’t want him to be alone when he dies.” The doctor then coldly added, “You are a Policeman. You should know better. Your friend is dead and the machines have been employed solely for the purpose of keeping his organs for transplant purposes.” Thanks.
I suppose to some degree the doctor might have been right about how I should have perceived the situation. After all, as a policeman you need to and do harden up as evidenced in my case by the fact that about five years prior to my friend shooting himself, while on duty, I shot a man who did not survive. The situation did not cause Post Traumatic Stress Disorder. In fact, the only thing that bothered me about the situation was that it didn’t bother me. That likely was due to the fact that the man was a real Bad Boy. Over a period of one year, he had committed 57 home invasions involving sexual assaults and robberies of mostly elderly female seniors. The loss of my friend however, for me and many other policemen was very dramatic.
Contrary to many people’s point of view, not every policeman, in fact most that leave the job before retirement are not washouts. They have simply had enough and feel the need to move on such as in my case. For me, it was because I didn’t then, and as stated earlier, do not now want to herein talk about the specific reasons John Sheffield was let go. Not talking about it, if I had remained on the force would have been a very difficult chore at best and likely not possible for me to live up to. Therefore, I left.
The day I quit the employ of Vancouver City Police precipitated by the advisement of Sgt. Larry Young’s death, I was assigned to working as an Acting Corporal at the Public Information Counter. I had been transferred to there on a temporary basis about two weeks prior. I had just competed for and was eventually put on the list for permanent promotion to the rank and pay of Corporal/Detective. Being a Detective was something that I always wanted and worked toward. So, there was considerable motivation to stay. But the confusion in my mind at the time caused me to make the different decision. VPD was considerate to me by offering me one year to change my mind and return. However, in very short order, I became a Private Investigator owning my own firm with a partner with no thoughts at that time of going back. Many times later, yes.
Initially, the PI work that we were able to come up with was stuff that I really did not enjoy. Why you may ask. Well, simply put is that PI guys receive all kinds of requests for service from the general public. The requests were not always righteous ones. Even when the requests for service were righteous, I just at that time didn’t feel like feathering every client through the process, which is what they needed because to them, it was all new. Also, being as protective as I am of always doing the right thing for the right reasons caused me to turn down a lot of those requests, which then caused me to wonder if our PI adventure would ever fly. Well, it certainly did fly once my partner and I began to work on behalf of ICBC a Crown Corporation, which had legitimate concerns, which ICBC demanded be handled in a legitimate manner. Furthermore, the feathering was gone because for the most part, to the insurance adjusters who hired us, it was all old hat. In this new environment, I found that I could still in a manner be the “Detective” (a term that we PIs are not allowed to use to describe our firms or activities) I always wanted to be. For a long time, working on behalf of ICBC as a mainstay was smooth sailing. During that time we also accepted worthy private client cases wherein I developed the patience to work closely with them because their needs are important and do deserve the extra attention. The variety offered by the private clients then became refreshing.
Regarding ICBC per se, there were periodic short term hiccups at various points relating to ICBC budgetary constraints. However, over the last couple of years or so, I have come to question the motives of ICBC upper management, which I know to have had serious impact on me and my fellow PIs who also in the past decided to make ICBC their mainstay in business. The current upper management’s motives in relation to how they run the business of providing compulsory insurance to the public, I know will also in short order cause financial harm to that public. Therefore, in the absence of ICBC employees talking about the ills they know are there, there is the requirement for someone else to stand up and say, “Enough is enough. Get back on track and stay there.” Should that person be me? Will I have any impact on the situation? Time may tell.
Standing up and biting the hand that has fed you, especially if one expects a continuance of that is probably never a good idea. That selfishly is something that I did not do until recently. Over the last year and a half or so, maybe two, while many PI firms and their employees were being punted out the ICBC door, I was kind of limping along with a little ICBC work and hoping for a turnaround in corporate attitude. I was during that time frame dealing with mostly claimants who had been identified as “criminal types” and therefore worthy of attention, certainly not to be ignored. At this current time however, while now also feeling a more significant shove out the door due to ICBC’s ongoing mandate, which is to reduce or perhaps eliminate outside expenditures such as PIs, Independent Adjusters etc., those outside expenditures for ICBC appear to have almost been eliminated. This short sighted corporate attitude and application only causes short term gain at the expense of long term pain. It does not take a Rocket Scientist to figure out that ultimately the money that ICBC does not spend today to combat fraudulent and exaggerated claims by using PI services will ultimately, and even much more so end up in the pockets of fraudsters and malingerers if ICBC doesn’t do the investigations and required surveillance themselves from within. There is a lot of money up for grabs. Will the cheaters go away especially if the process turns into a cakewalk for them? I don’t think so. As it stands, I know that ICBC Adjusters and Examiners are currently scrambling to settle tons of files that have not been properly prepped for litigation. In the meantime, new claims are continuing to back up. The lawyers are wringing their hands and threatening to litigate anything they can because they know that they have a better than even chance in court due to ICBC’s lack of evidence consequent to discontinuing the use of PIs. Disproportionate payouts seem to be the order of the day. Is this a righteous situation? Is this what the public would agree with if the public knew how ICBC of late has conducted itself? Despite the often heard whining from some people about having been screwed by ICBC, I still believe that the public would not support the current model that easily allows exploitation of the system for undeserved financial gain.
I know that ICBC upper management does care about public opinion. That is why when criticized publicly by the Private Investigators Association of BC via a CBC News Special aired on April 07, 2011, the ICBC spokesperson, in order to deflect the criticism retorted with falsehoods. That person, on camera stated that the PIABC criticism of ICBC was self serving and added that the corporation has an in-house unit that is taking up the slack in relation to what the PI’s used to do for them and will continue to use PIs in a limited way, but only when necessary. The spokesperson added that they won’t spend money needlessly. Well, no worry there. That hasn’t happened. In fact, it appears that there is even less work being assigned to PIs at this time after the CBC News Special.
In response to the ICBC spokesperson’s comment relative to that ICBC has an in-house unit that is picking up the slack, I say, “Not so. The ICBC Special Investigation Unit personnel for logical reasons related to liability have not in the past and likely will not in the future conduct surveillance themselves. The SIU members don’t even carry the appropriate insurance coverage on their personal vehicles in order to support that proposition and ICBC does not provide vehicles for that purpose.” By the way, surveillance is a very significant part of investigations, most particularly as it relates to an insurance company’s ability to defend itself from fraudsters and outright malingerers. A book on that subject matter alone could be written and likely already has.
The ICBC spokesperson, further to his retort to PIABC comments regarding the lack of PI usage, did admit that they were at that time experiencing a $100 Million increase in Bodily Injury claims costs, which they could not explain. A shot was taken at blaming increased medical costs. I offer little comment on that point. I don’t hold the records. So, I don’t know if that is a problem. If it is, it would likely be due to the increasing presentation of closed head injury claims, not all of which are legitimate. Fibromyalgia used to be the fad. Either way, increased medical costs are not the only problem. I venture to guess that there will be an even much higher increase in Bodily Injury Claims costs in the future due to the current corporate mandate to reduce outside expenditures. This opinion is derived at by me despite the fact that subsequent to the CBC News Special during which time there was an admission that there was a $100 Million dollar problem at hand ICBC offered a 3% rate decrease to its policy holders. What’s with that? Buying time are we?
A point that has not yet been brought up is that ICBC has offered bonuses to those managers who promote their front line adjusting staff into short term cost saving procedures such as not hiring outside resources. Wow. Not being naive, I sense that could be a problem.
As far as the ICBC spokesperson’s opinion about PIs being self serving, I say “Yes, we are to a degree. However, we are also concerned about the ramifications of what ICBC is doing because the current process will adversely affect the public’s purses and we too are part of that public.”
You may wonder after reading this opinion piece up to this point why I mentioned so much of the police stuff. I did it to try and offer some measure of credibility by letting the reader know what kind of guys and gals are out there doing PI work on behalf of ICBC and the public at large. Most PIs in general, whether they have police experience or not are capable and credible. If they lack experience in the first instance, with proper supervision and mentoring they quickly make the grade and provide quality service. They too have their own stories to tell if anyone will listen. They, like me are not feeling very good right now about being punted out the ICBC door for no good reason, especially in the manner that it is being done. It feels like a deliberate slow bleeding process for a not yet identified reason, which might present at a later point in time.
Yes, there is a self serving attitude within us all no doubt. However, I say to ICBC upper management, “You know that the police, despite the fact that Insurance Fraud is a crime, the police don’t investigate ICBC Fraud cases. They apparently have more important matters to attend to while being understaffed. Does that not put the onus to protect the public’s premium funds onto ICBC? Is that not why ICBC SIU members have Peace Officer status? Why don’t you spell out what your real plans are? What are you afraid of? Why all the secrecy? Give some sound reasoning as to why you are doing what you do. If what you have to say is reasonable and sensible, we will shut up. We will take our lumps and in my particular case, I shall chalk the whole 24 year adventure up to almost having been a good deal. It would have been much more appropriate for ICBC to have come clean with whatever plans the corporation has much earlier. Some of the individuals concerned would not now be in the position they are in today, almost impoverished due to having awaited for so long for a return to common sense. In any case, for many it is already too late.”