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Insurance Fraud Investigations

False insurance claims cost Americans billions of dollars every year.  It is the second most costly white-collar crime in the U.S., behind tax evasion.  In today’s challenging economy, more people are submitting false insurance claims in hopes of receiving an undeserved financial benefit.

Insurance fraud occurs when a false claim is submitted to an insurance company in hopes of receiving monetary gain.  Exaggerating loss or injury to increase your claim is also considered fraud.  Workers’ compensation fraud, staged accidents, arson, and false theft reports are a few common examples of insurance fraud.

Workers’ Compensation Fraud:

Employees are guilty of workers’ compensation fraud when they submit false insurance claims in order to gain personal benefits.  This may include claiming an injury happened at work when it did not or exaggerating injuries to receive disability benefits.  Some behaviors that may indicate a false workers’ comp claim include:

  • Multiple claims submitted in the past
  • No witness to the injury
  • Delay in receiving medical treatment
  • Provides different accounts on how injury occurred
  • Injury appears to have occurred outside of workplace
  • Worker whose job is about to end
  • Medical documentation and physicians’ reports are altered or fraudulent
  • Disgruntled employee
  • New hire with questionable work history

Employers commit fraud when they knowingly withhold information to prevent their employees from submitting a workers’ compensation insurance claim.  They may lie about coverage or threaten the injured with job loss if a claim is submitted.

Staged Accidents:

Staged accidents vary from forced auto accidents to exaggerated falls.  Scam artists have become quite sophisticated over the years in staging accidents and receiving thousands of dollars in false insurance claims.  False claims of injury and property damage cost all of us money in the form of increased insurance premiums.

Arson:

Arson fraud is defined as intentionally setting fire to property in hopes of receiving monetary gain.  With the slow housing market and fragile economy, there has been an increase of home and car arsons.  These fires are set in hopes of getting out of car and home payments as well as receiving fraudulent insurance payments.  It is estimated that one in every four fires in the U.S. is the result of arson.

False or Exaggerated Theft Reports:

Insurance companies receive a large amount of claims for home and auto theft.  Fraud occurs when claimant asks for reimbursement for property not owned or exaggerates the amount or value of what is lost.  Some behaviors that may signal suspicion include:

  • Claimant has a lot of debt
  • Homeowner’s insurance has recently been increased
  • Hand-written receipts
  • No proof of items lost
  • Many heirlooms lost, whose value is difficult to establish
  • History of prior claims
  • Lack of police reports

Many victims of insurance fraud believe there is nothing they can do to prevent criminals from abusing the system.  In many cases, a private investigator can prove insurance fraud has occurred and can report abusers to the proper authorities.  Through surveillance, interviews, and various other investigation techniques, an investigator can determine if injuries and property loss are valid or fraudulent.

An investigator can provide videos, pictures, and detailed reports to authorities proving that insurance fraud has occurred.  Not only will the client save money by not paying fraudulent claims, but also scam artists are prevented from receiving undeserved monetary rewards from untrue insurance claims.

"People underestimate their capacity for change. There is never a right time to do a difficult thing. A leader's job is to help people have vision of their potential." – John Porter

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