True Crime of Insurance Fraud Video Number 71

Miscarriage Manipulation for Money

Rita was five months’ pregnant. Her entire family greeted her condition as an opportunity to make sufficient money for a happy Christmas in sunny Hawaii.

For four generations Rita’s family has lived luxuriously on insurance claims. Their last names changed more often than their underwear. Wherever they go, they carry a small plastic valve of soapy liquid and a small razor. Depending on the size of the town they are visiting, they stay a week, a month or a year. One member of the family will claim to have slipped and fallen in a restaurant or grocery store. With the razor they will induce bleeding at their hairline or on an arm or leg. They will be pleasant victims with no interest in profit. Grocers, and their insurers, rapidly and fairly settle their claims in fear that their injuries will increase.

Rita had been a professional claimant since she was eight. She fell in the most luxurious restaurants in Las Vegas, New York City, Baltimore, Washington, D.C., St. Louis, Missouri, and Beverly Hills, California. Shortly after she began to walk, her family taught her how to slip and look like she was hurt without actually causing any physical damage. By the time she was five she could limp on either leg, hold one arm limp, wince with pain when touched and give all the symptoms of a severely injured person.

By the time she was ten she had a clear knowledge of anatomy and knew all of the symptoms of soft tissue injury. Now, at 22, pregnant with the child of a sailor she met in San Diego whose name she does not remember, Rita is ready to move into major, profit making scams. Her brother Aaron would pose as her husband as they worked the major hotels and restaurants of Sacramento, California. At the Holiday Inn, she fell in a puddle of water in the lobby restroom where two innocent women ran to her assistance.

“Oh, my God!” Rita moaned. “Did I hurt the baby.”

Rita rode to the hospital with her “husband” sitting in the ambulance beside her, wringing his hands. They left their name, a mail drop address and a telephone number which connected to the family cellular telephone, with the hotel. She and the baby were found healthy and allowed to leave, although the doctor, because of the family history of miscarriage, noted on the hospital record that here condition was “guarded” and that she should cautiously watch for any spotting or other indication of a potential miscarriage.

In the next four days Rita fell in five hotels, two department stores and three restaurants in greater Sacramento. She rode to the hospital in an ambulance twice and visited a local chiropractor known to her family four times.

The family lived, and traveled, in three sixty-foot motor homes equipped with cellular telephones, a computer and all the comforts of a luxurious home. The family knew better than to be greedy. They never presented more than 10 claims each in any one city.

Rita and Aaron were reasonable people. They told the adjusters they did not wish to hire a lawyer. Although they were afraid they might lose the baby, the doctors had assured them that the baby was unhurt by the fall.

The adjusters, sensing an ability to settle the claim quickly before the baby was born, with possible extra damage, worked quickly to gain the confidence of Rita and Aaron. They wanted a release that would protect their clients.

They had no knowledge of Rita’s family history. Liability was clear. Independent witnesses observed a slick, soapy substance on the floor and on Rita after she fell.

Rita and Aaron were professional claims presenters. They played upon the innocence and good faith of the insurance adjusters. They would tell the adjusters:

“We don’t want money. We just can’t afford to pay the doctors’ bills. Please pay those for us and we’ll be happy.”

The adjusters, knowing the law and knowing that if litigation was filed Rita would be entitled to money for her pain and suffering, insisted that Rita take more money than the medical bills. Most of the claims were settled for between $6,000 and $25,000, depending on the generosity or gullibility of the individual adjusters.

Rita’s potential miscarriage brought her family over $100,000 for their stay in Sacramento. Her brothers, sisters, cousins and nephews falling all over the city generated another $100,000 in claims payments.

Their welcome in Sacramento worn thin, the family motor homes traveled west to San Francisco.

The motor homes were parked in a long term secure parking lot and the entire family boarded airplanes for a three week holiday in Maui.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

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