Kevin O'Connor, Chairman For New York Alliance Against Insurance Fraud

On the latest episode of the Building Black Biz podcast, Z100's Maxwell is joined by Kevin O'Connor who is the Chairman of the Board for the New York Alliance Against Insurance Fraud. Maxwell and Kevin talk about the awareness against insurance fraud, what insurance fraud techically is and how costly the issue can be for a business owner. In partnership with @DriveToyota

Episode Transcript

(00:00):
What's up everyone tapping in? Appreciateyou listening. My name is Maxwell,
and welcome to the Building Black BizPodcast. I'm joined today by someone who
has an amazing title. As Iwas getting to learn a little bit about
Kevin O'Connor, the senior special investigatorfor your Insurance and chair of the New

(00:23):
York Alliance Against Insurance Front, youfit all that on a business card.
Man. That's awesome. I dothem an ax FO. Good morning.
It's pleasure to be with me,dude. Thank you again for being a
part of the pod. And asI get to know a bit about you,
and as our listeners here get toknow a little bit about you,
I guess I want to start withUM. Where where did it start for

(00:45):
you? Where? Where did um? Where did the hunger to be a
part of you? Know? Eradicatinginsurance frond? When did I? I
was working for insurance company handling claimsan opportunity UM came about to become involved
in what's referred to as the specialInvestigation Unit, which looks into suspicious claims.

(01:08):
And I've never looked back. I'vebeen doing it about twenty five years
now, and uh, you know, very happy in my position so as
you say you stumbled into it,was it always just like that uh investigative
spirit? Was it the you know, the hunger to want more? Was
it the curiosity? Like what kindof drove you down that path as you

(01:30):
were thinking like, Yo, thisis um, yeah, this is this
is somewhere, this is this isthe path I want to follow. I
guess it was really more of anopportunity, A position opened that was promotional
opportunity, UM that I jumped onand once I got involved, I found
out that really is my passion.And as I said, I've been doing
it for over twenty five years now. As um as we had the chance

(01:52):
to to you know, talk tosome other um, you know, business
owners and businessmen and women as apart of this podcast. One of the
things that has come up in thepass with them, and I'm wondering with
you as well, was you're ina leadership role. But maybe it wasn't
and it probably wasn't that the entireway through with your career, Like how
important was it for you to findlike like a mentor or who was that

(02:16):
person that maybe gave you that opportunityor that opportunity when it presented itself that
you were like, Yo, thisis this is someone who helped me,
and now in your position as aleader, maybe you're doing the same for
someone else. Well, I've hadactually a couple of mentors in this position.
When I first got into the roleof special investigations looking at suspicious claims,

(02:38):
I was new to that specific area, and I started meeting people in
the National Insurance Crime Bureau and theCoalition against Insurance Fraud and kind again a
feel for what was going on countrywide. And it really was. I
was at the beginning of when theinsurance company started to really look into insurance

(02:58):
fraud. So I came into itat a good time, met some great
people, helped me along the way, and I'm pleased to pass on my
knowledge some of the new investigators cominginto today. Awesome. Awesome. So
here's where we start to get intothe mission of the New York Alliance against
Insurance Fraud. Yeah, what isthe mission? And or I mean,

(03:20):
or here's another way that we couldput it. Who is the New York
Alliance against Insurance Fraud? Well,the New York Alliance is a group of
insurance carriers, pretty much all theinsurance carriers in New York State or the
vast majority of them got together backin nineteen ninety nine and decided that they
can have a greater impact together inraising insurance for it than each carrier trying

(03:44):
to do it on their own.So the mission is that we're trying to
raise end us about insurance for itand each year we present a different campaign
on radio and TV and billboards onthe Internet and simply targeting different areas insurance
freud to raise people's awareness about insurancefraud and how coarsely it is and that
it's not a victimless crime. Soyeah, So with that there, you're

(04:09):
saying that there's there's different there's differentversions, there's different layers to it,
there are multiple multiple types. Whatare some of those different types? There's
a lot different types. Yeah,and each year will look at different area
try to raise awareness. We've attackedone mobile insurance freud, maybe on the

(04:31):
property damage end, or maybe onthe medical end, health insurance fraud,
life insurance fraud. And this yearour theme is works compensation insurance fraud.
You can do something to stop it. So what is it about this year
focusing on workers cop insurance fraud?Like, why is it that in twenty
twenty three, that's the you know, that's the one that's raising its hand.

(04:56):
Well, each year we get togetheras a group, the Alliance,
and and each carrier kind of presentswhere they think we should aim this year's
campaign. And it's been a coupleof years since we have a targetive workers
comp fraud, and we think wesee a rise in insurance for it in
workers comp, so we throw upas a good year to come back and
revisit workers comp fraud. And you'resaying, and what I've heard, you

(05:18):
know, just in the early stageof this conversation is the word team.
UM. That's another thing that comesup as a as a as a theme
within this podcast series and a lotof them in and when we get to
speak to how important is it tobe a part of a team. It
sounds like it's a foolish question,but you know, I mean, you
know, how how important is itto not go after um, not go

(05:40):
after this alone and to have youknow, a group of people after a
common a common goal. I thinkour message is much stronger when we come
off as a team. We're combiningour resources UM for each carrier to try
to raise insurance for it. It'scourse late, as you know, to
advertise the New York's say, youknow, is a big endeavor, and

(06:01):
we do a much better job andhave a much broader campaign when we pool
our resources together, and we're alsopulling our knowledge together. So I think
we come together with better campaigns thatput together in a more professional manner and
come across better and more knowledgeable forthe people. So I think it's a
win win all around to hand outas a team approach. And one of

(06:25):
the words that I heard you saythat we have heard you say a little
bit here is cost. And I'mlooking at my notes here and yeah,
man, um, it's talking onehundred and two bucks per person when we're
talking about insurance fraud workers cop insurancefraud. That's us. That's a lot
of money. When you think aboutthe amount of New Yorkers that we have
here, Yeah, it's a reallot of money. And again that's per

(06:46):
person work has confront each is ofcourse in every New Yorker. Yeah,
that's you and I and every otherperson, every kid, every parent,
every grandparent. One hundred and twodollars, So workers confer it alone is
costing a family of four over fourhundred dollars a year in the course of
higher premiums and the price of highergoods and services because all those courts get
passed back to the consumer. Andand um, what I'm assuming and I

(07:12):
hope I'm not jumping to a conclusion, but it feels like, um,
you know that that you're you're makingI want to say, a personal mission,
but it's it's important to you toyou know, to help. And
I'm doing the air quotes here likethe you know us the little guy.
It's it's you know, everyday person. I mean, it's almost like you're
you're like a It's it's like superherotype work that you're doing, you know

(07:34):
what I mean, You're kind oftrying to, you know, eradicate these
problems that you know, not toput a broad stroke over it, but
you know that that folks are villains, are doing, you know, for
the sake of us being the onesthat really are confling up the money at
the end of the day. Yeah, and we've realized that probably the best
tool out there to find insurance forit is knowledge. So our soul mission

(07:59):
is to raise for at awanness.You know, we're not we don't provide
education to the industry. We're nottrying to facilitate UM getting arrest to work
with law enforcement. Was simply tryingto raise for an awareness. So the
average New york is understand what insurancefor it is. I mean, simply
put it's a deliberate deception perpetrated againstinsurance company for a financial gain. Well

(08:22):
really put it very simply, it'sa lie related to insurance to steal.
And I don't know if everyone recognizesthat. So all missions get out there
and let people know what insurance forit is and how it actually impacts them.
So how about how about an example? What um? Yeah, what's
like, what's one particular example maybea workers comp fraud that I don't know,

(08:43):
maybe by by an employee. Well, the most the easiest one to
give an example as someone who maybegot hurt UM not at work. Maybe
they're planning stoffball over the weekend andthey twist their ankle and maybe they don't
have health insurance and they don't knowwhat to do, so they wait till
Monday morning and they go to workand they say that they tripped work and

(09:05):
twisted their ankle. And if that'sthe case, now work is comp is
gonna pay for all the medical,it's gonna pay for the lost time while
they're out, but they weren't injuredwork the non titled that they're stealing the
benefit that they shouldn't be received.And I mean, how does one get
how does one get get caught bydoing that? Is it you know a

(09:26):
matter of you know, the teamgoing through the valance um just you know,
a question and answer type, Butlike, how how does one how
do you investigate that? That's interesting? Well, there's a few ways.
I mean, new claim is commein every day and insurance carriers look at
the claims and you know, weapproach it from the claim is a legitimate
claim. But when something jumps out, then maybe on the initial first report

(09:48):
they insured, sorry the injured partysaid something that seemed a little off.
They may refer to the special investigationunit to say, hey, we think
you should look closer at this claim. And the goal of the special investigation
unit for every insurance carrier is notto prove fraud. We're not trying to
nail somebody. We're just trying tomake sure the claim is legitimate. But

(10:09):
if it's a non legitimate they're allgoing to take the appropriate action. Got
it. So yeah, So themission isn't to go out and try to
bust people and how we can.It's just just to ask the questions to
make sure that's okay. So thatway that person or that group of individuals
isn't continuing on to go down thispath then, um, you know,
I mean, gosh, I meanthe harsh words, but don't mean to

(10:31):
but just to continue to go onand recabo when when that shouldn't be the
case in the very first point,And another way we find out about potentially
fraudulent claims is people tend to talkand say something because they don't take a
big deal what they're doing, andmaybe a column free um here is it
and goes to their HR department ortheir bust What makes an anonymous cool saying

(10:56):
hey, I think that claim isfraudulent and again that wind up investigated and
if it is fraud, the insurancecarrier is going to find out and they
are going to take the appropriate action. Now what about for um, like
like an example, for or byan employer, I guess not necessary by
an employee, but how does anemployeer, um, you know, commit

(11:18):
insurance fraud? And that's some pointto recognize to that insurance fraud is not
only by the uh, the littleguy, the employee. UM employees insurance
fraud too, but I have anunderhanded tactics that they misclassified their employees or
underreport payroll to their insurance carrier toget reduced premiums UM. An example might

(11:41):
be UM a roof and company thatsays they have a dozen office workers and
for roof is, when the realityis they have a dozen roof is and
only four office workers, so theyget a reduced So they're really stealing from
the insurance carrier too, and they'realso hurting buildedgitimate UM honest employees out there

(12:01):
who are paying on higher premium andnow can't compete against the cheatahs. Yeo,
that's that's really wow. That's amazing. And I'd also imagine that it
makes it even more difficult when um, you know, you have smaller businesses,
when you have those businesses that arethe mom and pop shops around the
boroughs or you know, around thecountry that are being forced to pay extra

(12:24):
because of somebody else's uh, youknow, devious UM you know, misrepresentation
of exactly who is working for them. Absolutely, the smaller companies, the
mom and pop industries are working onmuch tider morgin so when they're losing money,
because if someone else who's lying,uh, definitely hurts them. It's
a hard to compete. But soI just being honest and being open and

(12:48):
just being true with you know,either the claims that you're filing or the
way that you're reporting. What aresome things that people can do to make
sure that they don't fall down thesethese you know, these these pitall of
of you know insurance fraud. Well, I mean it's pretty simple, be
honest. If you're injured work,you know, report your injury. You're

(13:09):
entitled to work as compensation, you'reentitled to the treatment you need, but
don't lie about your injury. Youshould also be aware that, you know,
maybe if your employee offers you don'tpay for your injury, they don't
want to report it to works compand say they'll just pay cash for it,
don't worry about it. That's ared flag they might not have insurance.
Yeah, what if you need moretreatment down the road, surgery and

(13:31):
they gotta paid for that. Youshouldn't accept that. You should say now,
I want to do it the rightway, I'm entitled to works COMP
please file the claim and they reallyhave to do so. Work has Comp
as a mandatory insurance in New YorkState. Once again, everyone that's tapped
to appreciate you being a part ofthe pod. My name is Maxwell talking
to Kevin O'Connor, the Senior SpecialInvestigator chair of the New York Alliance Against

(13:54):
Insurance Fraud. Where getting a youknow, so much information here and as
you said, that's like the maingoal is just to make the consumers and
in those who are you know,business owners just aware of what insurance fraud
actually is. Um Are you seeingthat people are? Are they getting the
message? Are you know, consumersand employers both, you know, really

(14:16):
taking heed to the info that youall on your team has been able to
give out over the course of theyears. I do think they all,
but I think we have ways togo still. There's so a lot of
people out there who don't realize whatinsurance for it is. They see it
as a victimless crime. They feelthey've been getting their insurance premiums forever and
never made a claim. So it'sokay if I paid a claim and try

(14:37):
to get a little extra for myself. They feel entitled to it, and
you know, we want them tobe aware of that. Um, yeah,
it's a crime. You're stealing andif you're cold, you know it's
fine. You're gonna pay, andthere's potentially jail time too, and you're
gonna have to face your family withall this and the works compent. You
may lose benefits, you may havea significant interview that just lost benefits for

(15:01):
that, you're going to have topay out of pocket. You can lose
your job, you can get arrested, you have fines. So it can
be a very serious matter and weneed to let people know that well,
not to mention, like just evenhearing you explain it is I mean,
for a lack of better words,it's it's stressful. I don't know if
I want to deal with all that. You know, absolutely the stress it's

(15:26):
gonna put on your life could besignificant. You might have to explain to
your children why you lost your jobor why you had to retain an attorney,
and you know what the impact it'sgoing to have on your family life.
I don't think people think that fundown the road. They think it's
not a big deal, and itis a big deal when you get caught,
and you will get caught if youcommit insurance for out the insurance companies

(15:48):
are looking. I would recommend toall the employees some of the solutions they
could take, because if you suspecta claim might be phony or something's wrong
with it, or your insurance carrier, every carrier has a special basing it
that will look into it. Theywill not penalize honest claims. They're not
gonna beat up your employee. They'rejust gonna look into it. If they
find fraud, they'll act on it. If there's no fraud, the claim

(16:11):
will proceed as it should be,and the employees should look for some of
the signs. You know, maybesomeone's reporting they got hurt at work,
but they don't report it for manyweeks afterwards. Why was there a delay?
Yeah, that's a legitimate question toask. Make sure the medical treatments
related to the claim. So youknow, if you're an employee or employer

(16:33):
and you suspect something's wrong, evenif you're a witness, you know,
please report it. You're doing theright thing, and it's the same as
any other crime. You should reportit to the right people. It's yeah,
it's we see the signs on thesubway on the time, see something,
say something, I mean, andit's okay to you know, it's
okay to speak up. I mean, like you said, it's it's it's
just going to something that's investigated.And that's the most important part is that

(16:56):
if you let the process play out, then UM, that's what those positions,
that's what you're in your position for, is to do your job.
And remember you the ultimate victim,you, me and everyone listening right now,
you other people will paying the courseto this, so you have a
stake in the game. Yeah toum, as we get ready to button

(17:17):
things up here, I mean,how when we do see something and we
want to, you know, speakup or we you know really want to
you know, stick our feet firmlyinto doing the right thing as everyone should.
Um, where where do we go? Um? You know, is
this a is this a thing wherewe dial you know what I mean?
Three one one nine one one,Like how is it that? So where
we get in touch with with yourdepartment or with um, you know,
someone who needs to look into investigating. There's a couple of ways. I

(17:42):
would recommend that you go to ourwebsite freud Eny dot com or you can
call the Alliance at eight four fourfreud n Y to report it. You
can also call the insurance carry,your carrier or whatever carry is involved and
ask for the special investigation unit.They almost every carrier has a frount hopline.

(18:03):
You can get on the website andyou can call them directly. Information
will be taken and it will beinvestigated and if we get the report,
we will passing on to the propercarrier to look into the Lastly, you
know, how gosh man, howexciting is it for you to have you
know, maybe found that opportunity whenyou were first starting as you said,

(18:25):
twenty something years ago, to nowcontinue to do what you feel is you
know your purpose, your life's work, and to have a team, to
be a mentor to others and tosuccessfully you know, move along. And
I'm going to use the word againthis path and know that you are heading
down the right path, Like,like, what does it feel for you

(18:45):
to be in this career and tohave all these amazing titles on the business
card As we first started the conversation, Yeah, it's wonderful to work out
a job that you really love andyou get some satisfaction out of doing it.
Was great for me to start withbeing an investigator and look end insurance
for it and now be in aposition where I'm working with the entire industry

(19:07):
and I'm not just working on oneclaim. Now I'm trying to the alliance
just try to help fight the probleminsurance for it. That helps not only
my insurance carry I work for myemployee earing insurance, but helps all insurance
carriers and helps everyone. We're outto state. I'm paying premiums too,
so I'd love to see your reductionin the court of premiums and price of

(19:30):
goods and services. So yeah,I get great satisfaction of Joe, Well
I'm doing man, I can Ican hear the passion of your voice.
Yeah. I mean, the informationis what we all need moving forward.
And I mean, jeez, Ithank you for educating me. Um,
you know, making me aware ofLike you said, it's a crime that

(19:52):
I wasn't too aware of. Itdidn't even fully understand was one that's out
there. And now to uh yeah, to be a little bit more knowledgeable
going into it. I'm definitely goingto uh, you know, with a
little bit more well, with alot more open eyes and ears, and
you know, an understanding of youknow, doing the right thing is is
going to be is as always thebest thing. Well, I really appreciate

(20:15):
the opportunity. I spent some timeat it today and reach more people.
Encourage everyone to report insurance Freud freudny dot com or eight four four Freud
New York, and I'll leave youwith you. Please remember Freud, it
is the crime that you have payingfor. Really appreciate it. Kevin o'carnter,
thank you so much. Man.You enjoy the rest of your weekend.
Everybody who's dialed into the pod,we really appreciate it. Again.

(20:38):
My name is Maxwell, Mister KevinO'Connor true, Jim dude, you take
care, brother, Thank you verymuch. Che great Jake, you too. Cheers