“What we investigate here most often is theft or attempted theft when someone has created a scheme to gain more money than they are entitled to from an insurance company,” said Heather Gorton, crime analyst with the Washington State Office of the Insurance Commissioner.
Gorton is one of two crime analysts in a unit with five detectives and one detective sergeant. In any given year, the unit is responsible for reviewing approximately 1900 questionable claims of insurance fraud in Washington. Since the origination of the unit in 2006, 434 criminal cases have been opened.
Insurance companies operating in Washington are required by law to report suspected insurance fraud. When a report comes into the office, Gorton reviews the report to determine if a crime has been committed. The crime of felony insurance fraud may involve forged documents, identity theft, altered medical records, or lying about damages or losses.
“Just getting the time of an accident wrong is not a crime unless it was used to defraud the insurance company,” she explained. “The person has to have taken significant steps to perpetuate a lie and committed the act knowingly and with intent.”
Gorton gathers all the necessary documents to prepare a case for felony insurance fraud. These may include bank records, medical records, police reports, and phone records. She collects information about the person’s insurance habits and whether they have any previous instances involving claims for similar losses. She prepares a timeline. She presents the information to detectives who will conduct the criminal investigation and provides ongoing research and support as the case proceeds through the criminal investigation process. Through its investigations and prosecutions, the unit often recuperates lost money, which can range from a few thousand dollars to over a million dollars.
Gorton credits her coursework and experiences in the MACJ program with providing her with the skills and knowledge required for her work. As a student, she participated in research and analysis for various agencies, including the Seattle Police Department and Seattle Mayor’s Office. She analyzed a training course for a project with the Washington State Criminal Justice Training Commission. She conducted a qualitative analysis of input from community meetings to improve communication between the community and the Seattle Police Department. For the Seattle Parks Department, she researched people’s fear of crime in Seattle’s Westlake Park which resulted in significant changes at the park, including adding a children’s play area, art projects, and food trucks.
“The real world experiences afforded to the student are some of the biggest benefits of the program,” she said. “You are a student, but at the same time you are taken seriously, and having those results validated by that agency before you’ve even graduated is very exciting.”
“On an academic level as well as a very practical level, I’ve taken my degree and applied it directly to fighting crime,” she added. “The best part of the job is getting to work one-on-one with the detectives, seeing the resolution of these cases, and getting justice for the victimized company which in turn leads to justice for a victimized community. I am doing something for my community and the people of Washington. Supporting police work is the best way for me to fulfill my desire to work in public service.”
This story first appeared in our Summer e-newsletter. Read the latest and past issues of the newsletter and subscribe.