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socrateaser
socrateaser, Lawyer
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Experience:  Retired (mostly)
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My insurance rep lied to me repeatedly about my workmans comp

Resolved Question:

My insurance rep lied to me repeatedly about my workmans comp insurance. He even issued false certificates with fake policy numbers all the while I was not covered. What legal recourse do I have
Submitted: 1 year ago.
Category: Legal
Expert:  socrateaser replied 1 year ago.
First thing you do is report the crime to the State Workers Compensation Fraud Unit.

You can also sue the agent/insurer for the civil fraud and obtain damages if you are now subject to legal action by an injured employee. However, if the agent was working this scam on his/her own, there may be nothing to recover, in which case, regrettably, you would be wide open to liability for the injured employee's claims.

You may be able to fall back onto a general business liability policy, if you have such insurance -- so that would be something to look into. However, if the issue is simply that the agent has been taking your money and not insuring you, then consider yourself lucky, because you haven't committed any fraud, as you were (presumably) unaware of the scam until now.

Please let me know if I can be of further assistance.

Note: If you post a follow-up question, I'll be back with you later today. I have to go to court, so I will be unable to respond until the afternoon.

Thanks for your understanding and patience.
Customer: replied 1 year ago.
He never took my money. I continually asked if I was covered because I was not receiving a bill from any insurance provider. Every two to three weeks I would contact him with this question. And I was assured that there was nothing to worry about. I often times need certs for agencies and customers and he would provide me with them signed by him with policy numbers and policy periods. He even wrote in a insurance providers name. About a month ago he was not available when I would call. I was being told he was getting my messages but no return call was placed to me until after about four weeks when I asked when he'd be back and was told that they were not a liberty to tell me. At that point I spoke to the owner who told me I did not have workmans comp since last year.. I explained what his rep, who by the way is his son had been advising me, and was told he didn't say that. He suggested that I go to another agency for that policy. Now mind you I have been a customer of his for almost ten years. When I informed him that I had a signed cert from his son as described above he asked me to send him a copy. I have not sent him one. He put my company and my livelyhood in jeopardy. I now have to pay a premium for licensing to do business in an adjacent state because while I waited for him to correct a cert he provided the deadline has passed and I cannot do business there until I have a real cert to give them. This cost my company money while I wait for the process to happen there.
Expert:  socrateaser replied 1 year ago.
Good afternoon.

The fact that you were provided fraudulent certifications is proof of a fraud. Even if you did not pay the agent, the false representation in the certification is a criminal act, if you rely upon it to your detriment -- which you obviously have done. So, my answer is exactly the same.

If you have damages due to the unavailability of insurance, or from any other transaction related to your reliance on these certificates, then you can sue the agency, and you can report the matter to the state as a criminal fraud.

The only caution that I would make here is that you need to be able to connect the fraudulent certifications to the agent/agency (via some correspondence, such as a FAX identifier on the top of the certification, or an envelope showing the agency as the return address, or a collateral email or letter.

Otherwise, the government may think that you created the certifications, rather than the agent -- and that would place you at the center of the criminal investigation. Note that I'm not doubting your sincerity here -- I'm simply calling out the possibilities, so that you're not caught in the crossfire, between the government and the insurance agency.

Please let me know if I can clarify anything or assist you further.
socrateaser, Lawyer
Category: Legal
Satisfied Customers: 34823
Experience: Retired (mostly)
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