Arias Agencies Fraud Policy

Objective
The objective of Arias Agencies in implementing and enforcing this Insurance Fraud policy is to define Insurance Fraud specific to Life Insurance Sales, prohibit it in all forms, carry out appropriate disciplinary measures in the case of violations, and provide procedures for investigating lodged complaints or suspicious activity about conduct that violates this policy .

 

Scope

This policy applies to all Independent Contractors working within any business location under Arias Agencies selling Life Insurance.  All Independent Contractors are subject to immediate termination for any act of insurance fraud under this policy.

 

Defining Insurance Fraud

Insurance fraud occurs when an insurance company, agent, adjuster or consumer commits a deliberate deception in order to obtain an illegitimate gain. It can occur during the process of buying, using, selling or underwriting insurance. Insurance fraud may fall into different categories from individuals committing fraud against consumers to individuals committing fraud against insurance companies.  Insurance fraud not only imposes costs on insurance companies and threatens their competitiveness and future viability, but it is also financially damaging to consumers and detrimental to the economy and society as a whole.

In perspective to Independent Contractor’s working within Arias Agencies, insurance fraud is specifically defined as any action enacted by that Independent Contractor to write business that is not within the confines of Federal and State laws.

Examples of Prohibited Fraud

  • Misrepresentation of service whether it be in the client’s home or by phone.

Example of Fraud:

Telling them you are with the Union that represents them.

  • Writing business under an Agent that is not physically present in the home. The writing agent must be present in front of the client.

Examples of Fraud:

Accompanying agent for the writing of business is waiting in the car or an agent writes a policy with verbal permission over the phone.

  • Falsifying information on a Life Insurance application intentionally to avoid the policy being flagged or denied.

Example of Fraud:

Intentionally omitting health conditions, prescriptions and height/weight that the applicant has stated to the agent that are relevant to the application process.

  • Forging a Clients Signature.

Examples of Fraud:

The spouse types the policy holders name on the electronic application.  (The policy holder must physically type in their own name)

A client signs the initial application and calls the next day to revise information, the application needs unlocked for the agent to change information, the agent types the clients name.  (The client must physically retype their name)

Signing a client’s signature to any paper document, this includes oral specimen paperwork.  (The client must sign their own signature, regardless of paper or electronic application)

Examples given are not representative of all areas of fraud that can be enacted by an independent contractor in the Life Insurance Sales business.  These listed are merely representative of occurrences that are most frequently committed.

 

Responding to Conduct in Violation of Policy

Any information brought forth to Arias Agencies in any matter regarding any Independent Contractor committing fraud will be investigated immediately and reported to Simon Arias or an appointed staff member of his choosing.  Upon review of the complaint, appropriate actions will be taken immediately.

 

Managers, Supervisors, Independent Contractor

Any manager, supervisor or independent contractor working within Arias Agencies that is aware of any fraudulent doings by any other independent contractor is responsible to report such actions to the appropriate person.  Failure to do so, is contributing to the fraud being committed and disciplinary actions will be taken against that person as well.

Any manager, supervisor or independent contractor found to be a permissive advisor to commit insurance fraud under these scopes, will be terminated immediately.

 

Disciplinary Action 

Any independent contractor working within Arias Agencies found to have committed insurance fraud will be terminated immediately regardless of positioning.

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