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All the paperwork that was filed seemed to be in order. The claimant provided written representations on claim forms, as well as medical evidence, stating

All the paperwork that was filed seemed to be in order. The claimant provided written representations on claim forms, as well as medical evidence, stating she was unable to work as a disc jockey. Her insurance company approved the claim, and she began to receive total disability benefits. This continued for 18 months until the insurance company's internal audit department decided to follow up on the claim. The claimant was a 27-year-old, high school graduate who was vocationally trained as a disc jockey. Once the internal audit decided to follow-up on her claim, it was noted that she couldn't be reached in the afternoon during the week. This created suspicion and caused the insurance company to place her under surveillance. During the surveillance, she was taped traveling to an area radio station and recorded while on the air. The insurance company confirmed her employment with the radio station. Upon review, it was proven that during the same time she was submitting claim forms for her supposed injury she was working for this other radio station. By the time the case was referred to the law enforcement authorities, she had received $48,000 by materially misrepresenting her injuries. The investigation is still ongoing, and she has not been brought before a court of law. Unfortunately, this is not the only pending investigation of fraudulent claims for the insurance company. In just the past year, the courts have legally upheld two fraud cases and numerous allegations are currently under investigation.

  1. What were the fraudulent activities that the claimant committed?
  2. What do you think would be an appropriate sentence and/or fine for this crime?
  3. What measures could the insurance industry take to avoid similar payments of future fraudulent claims?

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