Publications

   
 Florida House panel discussion highlighted lawmaker concerns regarding the use of Artificial Intelligence (AI) in insurance decision-making.

This week, Florida’s House Insurance and Banking Subcommittee held a fact-finding hearing on AI use in insurance, recognizing the potential efficiencies it offers but alongside the need for oversight. Lawmakers were urged to distinguish between generative AI, which summarizes, drafts, and provides probabilistic analyses, and agentic AI, which would make fully autonomous decisions. It was pointed out that agentic AI is not currently used for complex coverage calls, exclusions, underwriting, or claim resolutions because it simply cannot interpret nuanced policy language. By contrast, fraud detection was described as a "big use", with AI models flagging potential suspicious activity for human review before escalation. Committee members focused on disclosure, transparency, and regulatory gaps, noting that consumers are often unaware when AI influences claim outcomes or pricing. “This is going to be an ongoing learning process for all of us,” House Insurance & Banking Chairman Brad Yeager said at the end of the meeting. The discussion framed AI as a strategic tool for insurers while underscoring the need for measured, consumer-focused regulation to prevent insurance fraud and protect policyholders. Recognizing these challenges, both the NAIC and NCOIL are proactively shaping state-level frameworks to govern AI in insurance. NAIC’s model bulletin and adoption map reflect growing state oversight of AI transparency and accountability, while NCOIL’s draft model law seeks to guide responsible innovation. These efforts align with the Coalition’s legislative priorities to balance consumer protections with the ability to responsibly leverage technology to fight insurance fraud.

Ned Gaines appointed Nevada Insurance Commissioner, bringing decades of regulatory and industry experience to the Silver State. The Nevada Department of Business and Industry has announced the appointment of Ned Gaines as Commissioner of the Nevada Division of Insurance effective October 6, 2025. Gaines, who has been serving as Acting Commissioner since July, brings more than 25 years of experience spanning both insurance regulation and private sector leadership. His tenure with the Washington State Office of the Insurance Commissioner and his extensive work in claims management and compliance position him well to guide Nevada through complex insurance challenges. "Serving Nevadans as Commissioner is an extraordinary honor," said Ned Gaines. "I am committed to ensuring Nevadans have access to a fair insurance market and to strengthening the Division's work on consumer education, market oversight, and industry engagement. I look forward to continuing our work with the Department of Business and Industry, insurance providers, and community partners to protect consumers and promote a stable insurance market for Nevada." As a reminder to fraud fighters, it is the Nevada Office of Attorney General Fraud Unit who maintains both an Insurance Fraud Unit and Workers' Compensation Fraud Unit in that state.

Coalition continues 2026 planning for legislative priorities. Each fall, the Coalition Against Insurance Fraud’s Government Affairs Committee begins its annual process of shaping next year’s legislative priorities, and that work is now well underway in advance of the upcoming Annual Meeting. This is a key time of year when Coalition members identify trends, and help set the direction for the Coalition’s 2026 advocacy agenda. As preparations continue for the Annual Meeting, the Coalition encourages all members to share ideas and perspectives to help refine the 2026 legislative priorities. Input may be sent to Brent Walker, Director of Government Relations, at brent@insurancefraud.org.

     Consumer Alert: Crime of “staged car
     crashes” is costly and on the rise in NYS

Citizens for Affordable Rates (CAR) today issued a consumer warning urging New York drivers to be vigilant against staged car crashes. Criminal networks that are a major driver of the state’s skyrocketing auto insurance costs. The warning accompanies a new fact sheet detailing how these schemes operate and their impact on every driver’s wallet. “Staged car crashes are not a victimless crime,” said CAR spokesperson James Freedland. “They’re organized networks that prey on unsuspecting drivers and force law-abiding New Yorkers to pay higher auto premiums. We’re issuing this warning so consumers can protect themselves in this affordability crisis — and to urge Albany lawmakers to take action before insurance costs skyrocket even further.” Staged crashes and inflated medical claims account for 75% of all insurance fraud cases in New York (NYS Department of Financial Services), adding an estimated $300 per driver per year.

Van fleets warned about insurance fraud. Operators of light commercial vehicles have been warned of the heightened risk of becoming a victim of insurance fraud. The Association of Fleet Professionals (AFP) said fraudulent insurance claims are rising, with criminals deliberately targeting commercial vehicles. “Lone drivers present only one witness to counter the fraudsters’ claim and commercial vehicles are pretty much guaranteed to have valid insurance, making them a better target,” said Martin Evans, chair of the AFP’s Risk and Compliance Committee. Examples include ‘crash-for-cash’ scammers who deliberately cause an accident so that they can blame the innocent driver. These cases often involve a moped or motorbike that rides head-on into a fleet vehicle, or riding past just as a driver opens the vehicle door, so that it hits the motorbike. The criminals then seek compensation from insurance companies. Detective Chief Inspector Tom Hill, from the City of London Police’s Insurance Fraud Enforcement Department (IFED), said: “The value of the claims that can be lodged for repairs, personal injury and replacement vehicles makes this an incredibly lucrative opportunity for fraudsters.”

The complaints don’t include the amount of false reimbursement and his trial is set for Feb. 10 in Linn County District Court. 

• Register to receive information about the GIFS and attend their Report to the Nations conducted in June of each year by using this link to establish your membership log-in credentials.
• Once you are approved, you are then invited to create your own professional profile on the Global Insurnace Fraud Directory. This is the first-ever world-wide listing of insurance fraud professionals. Only viewable by registered members of the GIFS, the Directory is open to all anti-fraud professionals including insurers, regulators, law enforcement and professional service providers.
• This year's Global Summit will be in Toronto Canada from October 19-22. Attendance at the Summit is by invitation only. If you are interested in being a part of this, or future, Global Summits you are welcome to submit an application. Summit sponsorships are still available which include 2 complimentary registrations. To find out more about becoming a sponsor just send an email to director@globalfraud.org.