The Louisiana Department of Insurance has served two producers with cease and desist orders, summary suspensions, fines and license revocation notices, LDI announced June 11 in a news release.
LDI fraud investigators served insurance agent Joel Stephen Martinsen of Luling with a cease and desist order, summary suspension, $3,500 fine and notice of license revocation on June 2.
Martinsen allegedly submitted fraudulent declaration pages or certificates of insurance while conducting the business of insurance.
In April, Progressive Insurance identified suspicious behavior exhibited by Martinsen, according to the C&D order. Progressive found seven instances of declaration pages which were submitted by Martinsen and appeared to have been altered to confirm that the applicant had a prior commercial policy of insurance when in fact the applicant did not have prior insurance. Martinsen purported the applicants had prior coverage with Liberty Mutual, but Liberty Mutual confirmed that the policies were not valid, contained fraudulent information and invalid policy numbers, according to the LDI order.
The telltale indications that something was amiss were the insured’s name and policy number were a different font than the one used on the remainder of the declarations page, and the premium for all of the policies was the same amount, $3,272.
In April, Progressive notified Martinsen’s employers at Terrebonne Insurance Agency of the findings of the insurer’s audit and that Martinsen would no longer be allowed to write Progressive policies, according to the order. On April 20, the agency terminated Martinsen’s employment. Upon separation from the agency, Martinsen admitted to manipulating the rating system and submitting the fraudulent documents in order to get a lower rate for the commercial customers.
In the order, the LDI advised Martinsen that the administrative action would be reported to the National Insurance Producer Registry and that he may need to report the administrative action to other states in which he holds an active license.
LDI records show that Martinsen was issued an individual producer’s license on Oct. 7, 2002. He has 30 days from the time of service to request an administrative appeal or the actions become final.
Opelousas Agent C&D’d
Investigators from the Insurance Fraud Division at the LDI served insurance agent Leslie Claire Trahan of Opelousas with a cease and desist order, summary suspension, $4,000 fine and notice of license revocation on May 11.
Trahan was C&D’d for allegedly including false information on or related to insurance applications, forging names on applications, receiving commissions on insurance policies based on fraudulent applications, withholding premium payments and paying premiums for insurance policies that consumers did not request to generate commissions.
In December 2020, a review of Trahan’s contracts was conducted by Funeral Directors Life Insurance Company (FDLIC) after discrepancies were found during the insured’s medical review process, according to the May 11 C&D order. The review turned up a pattern in which the physician’s office listed on the contracts did not recognize the insured as a patient. In the case of several contracts, the insureds were deceased prior to submitting the application or the date of birth was changed to make Trahan’s commission higher.
FDLIC discovered several cases of premiums being paid “check by phone” from Trahan’s account. In the case of one insured, Trahan accepted $3,590 in payment on the pre-arranged funeral contract and the money was not forwarded to FDLIC.
On Jan. 7, Trahan met with representatives of FDLIC, Legacy Funeral Services and the Evangeline Parish Sheriff’s Office to discuss the findings of FDLIC’s review. An FDLIC representative advised Trahan that the company had “compelling evidence” of insurance fraud.
According to the order, Trahan confessed to adjusting the age of the applicant for insurance on applications. Relative to the contracts issued after the insured was deceased, Trahan said she did not know the insured was deceased. She admitted to obtaining the insureds’ names from leads, completing the applications and paying the premiums out of her account.
When asked at the meeting what had happened, according to the order, Trahan responded that her husband had been in a wreck in 2020, and when the pandemic occurred it was hard to recover. Trahan claimed the fraud only affected contracts written in 2020.
At the conclusion of the meeting, the Legacy representative notified Trahan that she was terminated and advised her that he would delay filing criminal charges if she repaid the unearned commissions in a timely manner. On Feb. 22, Legacy notified Trahan by letter that the outstanding balance of $36,383.83 was owed to the company. The letter directed her to submit the payment to Ardoin Funeral Home within 30 days. According to the order, Trahan submitted a cashier’s check for the full amount on March 19.
The administrative action will be reported to the National Insurance Producer Registry, and Trahan may need to report the administrative action to other states where she holds a license.
Department records show Trahan was issued an individual producer license on Aug. 23, 2010. She has requested an administrative appeal.