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January 2021
Arrests  |  Convictions  | Submit a Referral

Allegheny County Man Charged with Defrauding Disability Insurer

On January 21, 2021, Randcliff Oliver was arrested in Allegheny County.According to the criminal complaint, Oliver claimed that low back pain caused him to be disabled from his job at Zoll Medical Corporation beginning on November 13, 2018. Oliver received short term disability benefits from December 3, 2018 through March 2, 2019, then transitioned to long term benefits.The complaint stated that on May 15, 2019, Oliver received verbal confirmation from The Standard Insurance Company that his claim for long term benefits was approved. According to the complaint, the insurer subsequently sent a letter to Oliver which stated that his benefit payment would be reduced if Oliver received any other income. The letter also instructed Oliver to notify Standard if he returned to work. On May 30, Oliver signed an EFT Disability Payment Option Request. By signing, Oliver allegedly acknowledged that he would be receiving benefits because he was disabled and that by accepting each payment, he certified that he “made no false claims or statements or concealed any material fact.” According to the complaint Oliver returned to work at Zoll Medical Corporation on June 17, 2019, but failed to inform the insurer that he had done so. Further, Standard received a Physician’s Report Form dated December 16, 2019, on which Oliver allegedly asserted that he was unable to work due to his medical condition. According to the complaint, Oliver received more than $16,000 in disability benefits from Standard, to which he was not entitled. Oliver is charged with one count of Theft by Deception (F3) and one count of Insurance Fraud (F3).
On January 26, 2021, Ryan Ortz was arrested in Butler County.  According to the criminal complaint, on October 1, 2020, Ortz’s vehicle rear-ended a second vehicle which was insured by a Farmers Insurance policy. Farmers contacted Ortz’s carrier, Progressive Insurance, and filed a claim for the accident. During the claim process, Progressive interviewed Ortz, who allegedly stated that the accident had occurred while he was driving to work. However, the complaint stated that according to Ortz’s manager, the accident occurred while Ortz was working as a delivery driver. According to the complaint, Ortz’s Progressive policy excluded coverage for vehicles used for the purpose of making retail or wholesale deliveries. Progressive denied the claim. Farmers paid $4,957.27 for the damage to its insured vehicle.  Ortz was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).
On January 26, 2021, Michelle Pamplin was arrested in Allegheny County. According to the criminal complaint, Pamplin was operating her insured vehicle when it was involved in an accident with another vehicle on May 1, 2019. Pamplin’s vehicle was covered by a Progressive Insurance policy which allegedly was obtained in the name of one of Pamplin’s friends. According to the complaint, when Pamplin spoke about the accident to a Progressive representative, Pamplin claimed to be her own sister and told the insurer that she (the sister) had been driving the insured vehicle at the time of the loss. According to the complaint, Progressive paid $2,828 for damages to the other involved vehicle and paid $2,000 to an occupant of that vehicle who was injured in the crash. However, according to the complaint, an investigation subsequently revealed that Pamplin, who did not have a valid driver’s license and was excluded as a driver on the policy, was operating her vehicle at the time of the accident. Pamplin is charged with one count of Insurance Fraud (F3), one count of Theft by Deception (F3); and one count of Identity Theft (F3).
On January 25, 2021, Benjamin Ploski was arrested in Westmoreland County.  According to the criminal complaint, on June 5, 2020 at 12:11 PM, Ploski was driving his vehicle when it struck an unoccupied vehicle that was parked.  Ploski allegedly notified the parked vehicle’s owner and admitted that he did not have insurance.  The complaint stated that at 4:51 PM that same day, Ploski obtained an insurance policy for his vehicle from Capitol Insurance.  On June 8, 2020, Ploski allegedly provided a recorded statement to the insurer in which he claimed that the accident had occurred on June 6 at 12:00 PM, after he obtained the policy.  According to the complaint, a forensic examination conducted on security video footage revealed that the accident occurred at 12:11 PM on June 5, which was prior to the inception of Ploski’s coverage. Capitol Insurance denied payment of the claim. Ploski is charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).
On January 25, 2021, Amanda Myers was arrested in Montgomery County.  According to the criminal complaint, Myers vehicle was struck by another vehicle at 8:12 PM on May 20, 2020. Myers allegedly obtained an auto policy from Progressive Insurance at 9:00 PM that same day. During an investigation of the claim, Myers allegedly told the insurer that the accident occurred after her coverage took effect. However, the complaint stated that the official police crash report confirmed that the accident actually occurred before Myer’s obtained the policy. Progressive denied the claim. Myers is charged with one count of Insurance Fraud (F3), one count of Criminal Attempt/Theft by Deception (M1), and one count Criminal Use of Communication Facility (F3).
On January 20, 2021 Michael Gilbert was arrested in Allegheny County.  According to the criminal complaint, Gilbert suffered a hand injury on March 22, 2018, while working at Triad Metals.  As a result, Gilbert began receiving temporary total disability benefits from AIG Insurance. According to the complaint, Gilbert was cleared to return to work at full capacity on January 30, 2019. However, he allegedly failed to report for work and continued to receive temporary total disability benefit payments from AIG.  According to the complaint, employment records obtained from Anchor Hocking revealed that Gilbert started working there full time on April 9, 2019. The complaint stated that Gilbert collected approximately $3,514.29 in total disability benefit payments while he worked full time between April 9 and May 26, 2019. Gilbert was charged with Theft by Deception (F3) and one count of Workers Compensation Fraud (F3).
On January 15, 2021, Theresa Edwards was arrested in Allegheny County.  Edwards’ husband Richard Robinson was arrested in Allegheny County on January 21, 2021.  According to the criminal complaint, Robinson was driving and Edwards was a passenger in the couples’ vehicle when it rear-ended another vehicle on November 25, 2019. Robinson allegedly suffered a broken finger as a result of the crash.  The complaint stated that although the vehicle was insured by a policy with Capitol Insurance, Robinson was not a covered driver. According to the complaint, Edwards provided a recorded statement to Capitol stating that she had been driving and that Robinson was her passenger when the accident occurred. According to the complaint, Capitol Insurance issued a check to Robinson in the amount of $14,000.00 to settle his injury claim. Investigators subsequently obtained a copy of the police crash report which allegedly revealed that Robinson was driving the insured vehicle when the loss occurred. Edwards was charged with two counts of Insurance Fraud (F3) and one count of Criminal Conspiracy/Theft by Deception (F3). Robinson was charged with two counts of Insurance Fraud (F3), one count of Criminal Conspiracy/Theft by Deception (F3) and one count of Theft by Deception (F3).
On January 11, 2021 Christina Schafte was arrested in Montgomery County. Her husband, Matthew Schafte was arrested in Montgomery County on October 26, 2020.  According to the criminal complaint, Matthew and Christina Schafte obtained a State Farm automobile policy for their Hyundai on December 24, 2018. Matthew allegedly contacted the insurer later that day and claimed that he was driving the Hyundai and that Christina was a passenger in their vehicle when it was involved in a deer strike accident. However, the complaint further stated that during a telephone call with State Farm on December 25, Christina claimed that Matthew had been driving the insured vehicle when it stopped working and had to be towed. But on January 18, 2019, Christina provided a recorded statement to the insurer in which she allegedly claimed that she had been driving the Hyundai when it was involved in a deer strike accident. According to the complaint, State Farm ultimately determined that the Hyundai had been involved in a two-vehicle accident which occurred on December 22, several days before the couple obtained the policy. The complaint further stated that the insurer confirmed that the Hyundai was impounded by the State Police following the crash and was parked in an impound lot on December 24, the date of Matthew Schafte’s purported deer strike accident. The claim was denied. Christina Schafte was charged with two counts of Insurance Fraud (F3), one count of Criminal Use of Communication Facility (F3) and one count of Attempted Theft by Deception (M1).
On January 6, 2021, Shareda Fitzgerald was arrested in Montgomery County.  According to the criminal complaint, Fitzgerald was involved in a two-vehicle crash in Philadelphia on Friday, April 12, 2019.  At 12:15 AM the next day, Fitzgerald allegedly purchased a Progressive Insurance auto policy and added collision coverage at 8:15 AM. According to the complaint, Fitzgerald phoned Progressive at 8:32 AM on April 13 and reported that her car had been involved in an accident during the evening of Friday, April 12. However, Fitzgerald allegedly maintained in subsequent verbal and written statements to the insurer that the loss occurred on Saturday evening, April 13. An investigation allegedly revealed that the accident actually had occurred on Friday, April 12, prior to the inception of Fitzgerald’s coverage.  Progressive denied payment. Fitzgerald was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt/Theft by Deception (F3), and one count of Criminal Use of a Communication Facility (F3).
On January 27, 2021 Shatika Phillips was sentenced in Allegheny County after entering into a negotiated plea to one count of Criminal Attempt/Theft by Deception (M1).  On December 14, 2019, Phillips obtained a Progressive Insurance policy for a vehicle that she had purchased during October of 2019. On January 9, 2020, Phillips removed the vehicle from her Progressive policy. Phillips again added the vehicle to her policy on January 29, but with liability coverage only. On the following day, she added comprehensive and collision coverage, which would take effect on February 4, 2020. On February 6, Phillips contacted Progressive and reported that her vehicle was involved in an accident on February 5. Phillips claimed that her vehicle’s front end was damaged when her vehicle left the roadway after she swerved to avoid a deer. A subsequent investigation revealed that the vehicle had been towed to a repair shop on January 30, 2020. Phillips claimed that the vehicle was towed after it stalled and began making noises. Progressive determined that the vehicle actually had been damaged in a crash which occurred prior to the effective date of Phillips’ comprehensive and collision coverage. Phillips was sentenced to serve 18 months of probation.  She was ordered to perform 50 hours of community service and to pay court costs.
On January 29, 2021 Kenton Lincoln was sentenced in Washington County after entering into a negotiated plea to one count of Criminal Attempt/Theft by Deception (M1).   On December 11, 2019, Lincoln purchased an automobile insurance policy for his vehicle from The General. On March 5, 2020, Lincoln reported to The General that he discovered that his vehicle was missing at approximately 10 AM that day. Lincoln told the insurer that he had not yet contacted the police but planned to file a report. On March 6, 2020, Lincoln filed a stolen vehicle report with the local police department. During the claim process, the General received an application from another individual who wanted to insure a vehicle with the same make, model and VIN number as the vehicle that Lincoln had reported as stolen. Further investigation revealed that the individual purchased Lincoln’s vehicle for $3,000 on February 26, 2020. The General was able to obtain screenshots of the text messages in which Lincoln and the individual confirmed the sale of the vehicle. Lincoln was sentenced to serve 18 months of probation.  He was ordered to perform 50 hours of community service and to pay court costs.
On January 28, 2021, William Royer was sentenced in Blair County after entering into a negotiated plea to one count of Criminal Attempt/Theft by Deception (M1). Royer made false statements to Esurance in support of a claim in which his nephew’s vehicle was damaged when it was struck by another car. The at-fault driver was uninsured at the time and subsequently obtained coverage from Esurance. Because Royer’s nephew did not have a valid driver’s license, Royer agreed to tell Esurance that Royer was driving his nephew’s vehicle when the loss occurred. An investigation revealed that the collision happened prior to the policy inception. Royer was sentenced to 30 days of house arrest followed by 11 months of probation.  He was ordered to perform 50 hours of community service and to pay court costs.
On January 20, 2021, Darren Mattocks was sentenced in Washington County after entering into an open plea to the charges of Criminal Attempt/Theft by Deception (M1) and Insurance Fraud (M1). Mattocks’ Progressive Insurance vehicle policy was cancelled for non-payment on September 1, 2018. He obtained a new Progressive policy on January 20, 2019, which took effect at 11:42 AM. On January 23, Mattocks filed a claim with the insurer for an accident involving his BMW X6. Mattocks told the insurer that he had been driving the car on the afternoon of January 20 when the BMW skidded on a patch of ice, went off of the roadway and flipped over. The damage to the BMW was estimated at approximately $48,234.38. A Pennsylvania State Police crash report revealed that troopers were dispatched to the accident scene at approximately 9:32 AM on January 20, which was prior to the inception of Mattocks’ policy.  Progressive denied the claim. Mattocks was sentenced to serve 18 months of probation. He was ordered to pay a $2,500 fine and all costs.
On January 28, 2021, Anthony Marco was sentenced in Philadelphia County after entering a negotiated plea to one count of Insurance Fraud (F3).  On November 17, 2017, Marco filed property damage and personal injury claims with Repwest Insurance and Safe Auto Insurance Company. Marco claimed that he had been exiting a parking lot on November 16 at approximately 9:00 PM or 9:30 PM when a U-Haul van insured by Repwest rear-ended his vehicle. When Marco filed a claim with his insurer, Safe Auto, he indicated that his vehicle was not operable and that he might require medical treatment as a result of the crash. Marco also filed a similar claim with Repwest and told the insurer that he did not know the driver of the U-Haul prior to the accident. When Repwest contacted the U-Haul driver, she stated that the crash occurred at 5:30 PM and claimed that she did not know the other driver prior to the accident. An investigation later revealed that Marco and the other driver had agreed to stage the accident in order to file fraudulent insurance claims. Marco and the other driver withdrew their claims with Repwest Insurance.  Safe Auto denied Marco’s claim for property damages and personal injuries. Marco was sentenced to serve 36 months of probation with drug treatment and ordered to perform 50 hours of community service.
On January 19, 2021, Allen Showell was sentenced in Chester County after entering a negotiated plea to one count of Theft by Deception (M1).  On June 16, 2020, Allen Showell was arrested in Chester County. On July 30, 2019, Showell called The General insurance company and added collision and comprehensive coverage to his vehicle policy. On August 1, 2019, Showell called Progressive Insurance and obtained an auto policy for the same vehicle. On August 4 and 5, respectively, Showell called Progressive and The General and reported that his vehicle had been in an accident on August 4. An investigation revealed that that his vehicle was damaged in an accident on July 30, before Showell’s obtained comprehensive and collision coverage from The General and before he purchased his policy from Progressive. Investigators confirmed that following the accident, Showell’s vehicle was towed to a repair facility and remained there through August 5, 2019.  Neither insurer paid Showell’s claims. Showell was sentenced to 24 months of probation and ordered to pay a civil penalty of $500.00.
On January 11, 2021 Catrina Denise Cryor was sentenced in Delaware County after entering into a negotiated plea to one count of False Application for Certificate of Title or Registration (M1), one count of Altered, Forged or Counterfeit Documents and Plates (M1) and one count of Criminal Attempt/Theft by Deception (M1). On September 10, 2019, Cryor’s vehicle struck a motorcycle while traveling on the highway. Cryor presented a Good 2 Go Auto Insurance identification card to the operator of the motorcycle, who subsequently filed a claim with the insurer. The insurer discovered that Cryor was not insured by Good 2 Go at the time of the accident. Moreover, the insurer determined that the Good 2 Go identification card that Cryor had shown to the other driver was counterfeit. Good 2 Go denied the claim. A further investigation revealed that on December 3, 2018, Cryor had used the same identification card as proof of insurance when she titled and registered her vehicle through a tag shop in Delaware County. Cryor was sentenced to concurrent terms of 36 months of probation on each charge.
(ARD) Dispositions

During the month of January, two additional defendants received Accelerated Rehabilitative Disposition (ARD). 

Anti-Fraud Compliance - Reporting of insurance Fraud to Law Enforcement Agency

Pennsylvania Bulletin Notice 2016-04 (issued April 30, 2016) reminded insurers of their obligations to report suspected arson or insurance fraud to law enforcement agencies within the Commonwealth.  The bulletin also announced a decision by the Pennsylvania Department of Insurance to allow licensees to satisfy their reporting obligation when they electronically submit reports of suspected fraud to the National Insurance Crime Bureau (NICB).
 
On July 6, 2017, Pennsylvania began participating in this online service which enables member companies to electronically forward reports of suspected fraud to the Pennsylvania Office of Attorney General’s Insurance Fraud Section or other appropriate law enforcement agencies at the same time the companies report suspicious claims to the NICB. NOTE: The NICB is not a law enforcement agency. Therefore, a licensee cannot satisfy the fraud reporting requirement by submitting a non-electronic (paper) referral only to the NICB.
 
Important: When utilizing electronic filing through NICB, users should take careful note of the provided instructions regarding the “Party” to a claim.  Information entered about a Party will only be transmitted to law enforcement if users select one of two options: “This Party was subject to an SIU investigation” or “This Party was subject to an enforcement action.”  Some users have missed this notation about individual Party data and consequently have submitted incomplete information to law enforcement.

This newsletter was produced by the PA Office of Attorney General’s Insurance Fraud Section and edited by Senior Deputy Attorney General John T. Dickinson.

Copyright © 2018 Office of Attorney General 
All rights reserved.


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