Since Sept. 2007, the North Carolina Department of Insurance has closed 442 cases for insurance fraud and recovered $14.2 million in restitution. Given that kind of success, Claims' managing editor Eric Gilkey sat down for a chat with the state's insurance commissioner, Jim Long, to find out how insurers and investigators can better work with their individual state departments of insurance.

Care to share with our readers the secrets to your success?

It's really all about the preparation that our investigators put into their cases and into their professions as a whole. We start by cultivating a crack staff of the best we can find. We have experienced white collar investigators, many of whom have been with NCDOI for years. They, in turn, cultivate relationships across North Carolina that benefit our cases. They have excellent relationships with all 42 district attorney offices and the three U.S. attorney offices in the state. Our folks prepare their cases for a thorough prosecution, and carefully eliminate those cases that they believe will not be accepted. That leaves us with strong cases that we can aggressively pursue once the district attorney takes them on.

Your department employs 20 sworn law enforcement officers dedicated to investigating claims of insurance fraud. Is this enough to deter crime?

We are about average in the number of investigators we have in relation to our population when compared to other states. As the number of case referrals go up, of course it would be nice to add a few more investigators. But as for deterring crime — it's not the quantity of investigators, it's the quality that counts. We have quality law enforcement officers.

How can insurers/adjusters/SIU in general work better with state departments of insurance? Can you offer any tips to insurers when referring cases?

It's important to foster communication between DOI investigators and SIUs from the get-go. We like to meet with the SIU shortly after receiving a referral from the company. At that meeting, we can let them know exactly what we need from the company in order to proceed with a successful investigation and prosecution. As long as we work hand in hand with the SIU throughout the investigation, we can avoid delays and misunderstandings. By keeping the SIU informed, we both know the direction of the investigation. When additional information is needed from the company, the SIU knows that immediately and also understands the reason for the request.

In insurance fraud, there's no end to the misguided creativity. What's your most memorable or noteworthy case?

The type of fraud that has me rooting for my investigators even harder these days is rate evasion. I've been in office more than 23 years, and during that time, I've worked hard to lower our auto insurance rates to sixth lowest in the nation. What do I get for my trouble? Drivers from New Jersey and other states that have skyrocketing auto insurance rates are faking their residency in North Carolina. They are taking advantage of our low rates when they don't really live here. I had no idea rate evasion was such a big problem until my chief deputy commissioner, a New Jersey native, shared this story. Her brother lives in a nice, normal neighborhood in Jersey. However, he recently counted more than 100 North Carolina tags on his neighbors' vehicles. All of those people — and possibly thousands like them — are cheating North Carolina's insurance companies and citizens. It's against the law, it's fraud — and we are working harder than ever to stop it.

Anything else you would like to add?

I'd like to congratulate all the staff of our Investigations Division for an excellent year in 2007. We arrested more than 100 people — a new record for our Department. Those men and women do a terrific job for the citizens of North Carolina, and they are to be commended.

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