INVESTIGATION REPORT. Field Adjuster Conflict of Interest. Date: March 13, Report Number: CPIC Report Number: CPIC

Transcription

1 INVESTIGATION REPORT Field Adjuster Conflict of Interest Date: March 13, 2014

2 Table of Contents: Page Report Background 1 Allegations 1 Audit Procedures 1 Audit Findings 2 Conclusion 2 Appendix Distribution 3 Audit Performed By 3

3 Report Background On February 21, 2014, a report was made to Citizen s Integrilink Alertline System by a Claims Manager of Citizens Property Insurance Corporation advising that a Citizen s Field Adjuster named [Subject] recommended a restoration company to work on repairs for a claim, which the Insured utilized for a short period of time. When the insured dismissed the contractor, he felt the Subject retaliated against him. Allegations A Conflict of Interest 1 exists between the Subject and a restoration company wherein the Subject is recommending a restoration firm and retaliating against insured when the firm is not utilized. Procedures Office of Internal Audit-Forensics (OIA-F) performed the following: Reviewed documentation to identify the relationship between the Subject and Citizens Property Insurance Corporation (CPIC). The Subject has been employed by CPIC as a Field Adjuster since Reviewed web-based information on the Subject and the restoration firm to identify any relationship with the restoration firm. No relationship was established based on these searches. Conducted a review of claim data extracted from Citizens Claim Tracking System (CTS) for claims assigned to the Subject with reported loss dates ranging from February 21, 2013 through February 21, 2014, covering a year prior to receipt of the allegation. OIA-F requested that Citizens Claims Quality Assurance (QA) Unit conduct a quality assessment on the Insured s two claims to identify any potential issues up to and including evidence of retaliatory behavior. OIA-F interviewed the QA Supervisor, the Insured, and the Subject. Findings OIA-F confirmed the Subject was: Not affiliated with the restoration firm at any time. Twenty-three individual claims were identified as having been assigned to the Subject during the audit period. Of the twenty-three claim files reviewed two were identified as utilizing the restoration firm. Both claims belong to the Insured in the complaint. No other claims were found in the period reviewed that utilized the named restoration firm. The QA review did not identify any instances that would indicate retaliation. The QA staff noted instances needing minor correction and provided these to the adjuster s supervisor 2, The QA Supervisor indicated that, while out at the Insured s property, the Insured advised him of his concerns with the independence of the Subject. The QA Supervisor had the insured fill out a customer service survey, which was provided to OIA. The survey contained the Insured s 1 Citizens Code of Ethics identifies a conflict of interest as occurring when a personal relationship influences a business decision, interferes with the interests of Citizens, conflicts with the proper discharge of a person s duties or leads to a disregard of a public or corporate duty. 2 Note: corrections noted were found to be minor by QA team. However, these corrections were included with all facts when providing conclusion. Page 1

4 Report statement of his experience with the Subject. He also forwarded the Insured s survey and comments to Citizen s management, The Insured indicated that he told the Subject that he had not had to deal with this type of claim before and asked who he could get {i.e. restoration firm}to help him. The Insured stated that the Subject said, "I can't help you on that. That is something you have to look up". The Insured pressed him and the Subject said "It's against my better judgment, but I have a guy that can help you. I worked with him before {per insured "or something like that"}". The Insured advised he signed an agreement with the restoration firm, but changed his mind later and advised the subject in writing and by certified letter. The insured also hired a Public Adjuster (PA) to assist him with his claim. He said the Subject then had an attitude change and went from a "10 to a 0". He said that the Subject would not talk to him by phone but would only talk with the PA or communicate to him by . He also said he felt he had to provide excessive documentation and did not get as much as he thinks he should have, The Subject advised that he had worked with the owner of the restoration firm previously at another insurance company before the owner started the restoration company. The Subject did state that while he is aware that recommending a firm is a violation of management directive, the Insured was pleading with him for help and felt that it was a matter of customer service due to the urgent nature and timing of the incident. He advised he would not have done that except that the customer was pressing him for assistance and that he was just trying to help, The Subject did recommend the firm to the Insured; however it was found to be out of a desire to help the customer. Conclusion The results from our investigation did not identify or substantiate any instances of a conflict of interest or retaliation as alleged in the February 21, 2014 allegation. However, the Subject did violate Citizen s Claims Management directive [3] of not recommending any vendors, contractors, or any other type of firm to our policyholders. It is recommended that management, with the support of Human Resources, assess the violation of policy and determine the most appropriate action given the circumstances and evidence provided in this report. [3] A communication was sent to all claims staff on 11/3/11 advising staff that it was not appropriate to refer contractors. It was also noted that a Claims Manager stated he advises his staff at virtually every meeting not to recommend any contractors. Page 2

5 Appendix 1 Distribution Addressees Steve Sherin, Manager- Claims Copies Tom Lynch, Citizens Audit Committee Chairman Juan Cocuy, Citizens Audit Committee Member Freddie Schinz, Citizens Audit Committee Member Barry Gilway, President/CEO/Executive Director Dan Sumner, General Counsel & Chief Legal Officer John Rollins, Chief Risk Officer Jimmy Johnson, Director- Claims James Adams, VP Claims Lori Andrade Dillingham, Director - HR Business Partner Mgt Christine Turner Ashburn, VP Communications, Legislative & External Debby Kearney, Ethics and Compliance Officer Bruce Meeks, Inspector General Johnson Lambert, LLP (External Auditors) Following Audit Committee Distribution The Honorable Rick Scott, Governor The Honorable Jeff Atwater, Chief Financial Officer The Honorable Pam Bondi, Attorney General The Honorable Adam Putnam, Commissioner of Agriculture The Honorable Don Gaetz, President of the Senate The Honorable Will Weatherford, Speaker of the House of Representatives Investigation Performed By Auditor in Charge Billie Sue Hamrick Audit Director Under the Direction of Josh Shilts Joe Martins Chief of Internal Audit Page 3