"Hush," they say. "You shouldn’t
talk about that," they say. "It’s not really an issue,"
Do they think that if they don’t talk about
it, don’t learn about it and don’t watch out for it, it won’t
exist? Hear no evil, see no evil, speak no evil – right?
The problem is, whether you talk about it
or not, fraud does exist. And it will continue to exist until
the industry as a whole – that includes you – learns what constitutes
fraud and how to fight it. You can’t just cover your ears, shut
your eyes and bite your tongue. You have to take a stand and speak
What is Fraud?
In defense, most people are probably unaware
of just what constitutes fraud. Ignorance, however, is no longer
Fraud comes in many forms and is perpetuated
by many sources – shop owners, insurance companies, vendors, workers
and customers. Fraud exists in the actions we take when confronted
with a situation of deception.
Webster’s dictionary describes fraud as "deceit,
trickery; specifically, intentional perversion of truth to induce
another to part with something of value or to surrender a legal
right; an act of deceiving or misrepresenting."
A legal definition of fraud reads: "Deceitful
conduct designed to manipulate another person to give something
of value by (1) lying, (2) repeating something that is or ought
to have been known by the fraudulent party as false or suspect
or (3) concealing a fact from the other party that may have saved
that party from being cheated. The existence of fraud will cause
a court to void a contract and can give rise to criminal liability.
Fraud can be found in every facet of business;
for example, when a shop owner pays technicians based on an amount
of time charged for a repair while charging customers for a different
amount of time, it’s considered double sheeting the workers to
make more profits. And that’s considered fraud.
How to Recognize It
When you look at how you conduct business
on a daily basis, do you pay attention to practices that may fall
under these descriptions? For the most part, no one does. Instead,
we all tend to reserve the term "fraud" for those blatant
activities so often exploited on the evening news.
But fraud isn’t always so obvious. Consider
this scenario: Recently, I was visiting a shop that had a customer’s
car in for repairs. All the parts needed for the repair were on
site – including an inner wheel housing listed on the estimate.
But no one was working on the car.
Instead, the shop manager and an insurance
appraiser were discussing whether the inner wheel housing really
needed to be replaced. The shop manager wanted to remove the part
and the labor required listed on a supplement; the appraiser wanted
to offer him a deal.
The manager, the appraiser said, could just
throw the new part in the trash and then use the money he would
receive for installing the part to pay for some additional procedures
that weren’t on the estimate.
After a little more discussion, an agreement
was struck. Does this constitute fraud?
Yes! By all means. The shop manager, however,
thought since the appraiser struck the deal, it was OK. He was
This is a blatant act of fraud toward the
insurance company, the shop owner, the technician and the vehicle
owner. Not only did the shop manager and the appraiser commit
fraud, they forced the insurance company, the shop owner and the
technician to unknowingly be party to their actions.
When making business transactions with customers
and their insurance carriers, be on the lookout for agreements
that may be construed as deceptive or fraudulent. Like they told
you in driving class, act defensively. Always expect the unexpected
and know how to react.
You should also be aware that this attitude
may, at times, cost the shop business – including DRP work. A
while ago, I was in an I-CAR Gold Class shop that held several
DRP contracts. The owner took great pride in being an I-CAR Gold
Class shop and geared his marketing toward that fact. His DRP
contracts, in fact, required the shop to be I-CAR certified.
After a little investigating, I found the
shop had at one time received I-CAR Gold Class status, but the
shop owner had since replaced most of his technicians – and their
I-CAR certifications were expired. I found only one technician
with valid certification for refinishing – and he was a body tech.
The shop owner hadn’t realized or checked the technicians certifications
for expiration or designation.
Does this constitute fraud?
Yes. The shop’s customers and the insurance
companies it held DRPs with were under the impression the shop
employed certified technicians. Even the shop manager thought
he had certified technicians.
Still, It’s Fraud
The way we conduct business today vs. a generation
ago has changed dramatically – it’s had to. There are now more
players and even more rules. What was once an accepted way of
transacting business is now suspect to fraud.
I remember hearing about a particular shop
caught by an insurance company for committing fraud when the shop
owner signed up for his first DRP. Business as usual at this shop
included the following practice:
If a customer wanted additional repairs performed
– beyond those written on the estimate – the shop technicians
would put used or repair damaged parts in place of new and then
use the difference in cost to offset the cost of the additional
repairs. But the shop still charged the insurance company for
the cost of the new parts and required labor.
The shop had conducted business this way for
years and never had a problem. The owner never considered it fraud.
He reasoned the money the insurance company was paying for the
repair was rightly the vehicle owner’s money and could be spent
as he or she wanted.
Is this right? No. The shop owner deceived
the insurance company by arbitrarily changing a repair contract
and charging for unrelated repairs. Who committed this fraud?
Both the shop and the vehicle owner.
Why Commit Fraud?
Many shop owners feel the only way they can
make money is to walk the fine line between honesty and fraud.
Often, however, they willingly cross the line.
A few years ago, I was in a shop that was
repairing a very expensive European car. The vehicle needed a
new wire loom that cost about $2,000. The shop manager couldn’t
get the new part right away because it had to be backordered from
Europe. So he located a partial wire loom at a salvage yard and,
using the used part, repaired the damaged loom rather than replace
I can’t tell you how many times he and his
technicians laughed about how they bought the used part for $200
and charged the insurance company $2,000. The shop manager said
that’s why they specialize in expensive foreign cars – because
it’s easy to make great profits. Shops like this perpetuate the
image that the collision industry is dishonest.
Another reason fraud is so prevalent in this
industry is because what’s considered fraud in one area of the
country is an acceptable practice in another. The repair industry
is a fragmented one. And without some kind of unity, some kind
of consensus on repair methods and business practices, fraud will
continue to breed.
Put a Stop to It
Because fraud is so rampant in the insurance
claims arena, most states, insurance companies and collision industry
organizations are attempting to level the playing field by writing
more laws and by pursuing those who commit fraudulent transactions.
At this time, there are several class action lawsuits against
insurance companies for fraudulent practices and deception. There
are also shops that are being pursued for fraud.
What can you do to put a stop to fraud? If
you question the way someone – including you and your employees
– conducts business, charges for repairs or performs work, speak
up and do something to put a stop to it.
There’s no reason to follow through with any
questionable practices. Remember, ignorance isn’t a defense. Neither
is, "We’ve always done it that way."
Business has changed and so must you. Closing
your eyes and keeping your mouth shut won’t make fraud disappear.
What it will do is make you an accomplice.
Writer Paul M. Elkins is the senior consultant
for Elkins & Elkins Consulting, a value-added, hands-on consulting
company that provides solutions to an owner’s areas of concern.
|Just an Accident – or a Chance for Fraud?
It was just a small auto accident. A fender
bender. A wrong turn at an inappropriate time. The damage wasn’t
too severe, but "not too severe" can mean thousands
of dollars. The injuries were minor, tempers flared, emotions
were high. Maybe there was a little discomfort, a few sore spots.
But all in all, it wasn’t as bad as it could
From an owner’s viewpoint: It’s damage to
From a repair facility’s viewpoint: Here comes
From an appraiser’s viewpoint: Here’s another
From an insurance company’s viewpoint: It’s
While not all individuals attempt a fraudulent
Reprinted from the Collision Industry Conference
|Dos & Don’ts Concerning Fraud
Reprinted from the Collision Industry Conference Guide To Fraud