Insurance Fraud Investigations

[ Illegitimate Insurance Claims ] [ Insurance Fraud ] [ Types of Insurance Claims ] [ Insurance Claim Investigation ] [ Evidence Gathering ] [ Red Flags ] [ Insurance Fraud Report ]

Insurance Fraud

Insurance Claims



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Illegitimate insurance claims

Illegitimate insurance claims cost billions yearly. Some still think that insurance fraud is a victimless crime. It is clear however that insurance fraud is a criminal act with the intent to deceive. The perpetrator wishes to get the insurance company to pay out more money than is legally required.

Thus these crimes are not without victims or consequences. Instead, we are all paying the price in the form of higher insurance costs. One reason for this is that all these false or unfounded insurance claims require an investigation to verify if they are legit. Such types of investigations can be very costly.

When fraudulent claims emerge or remain undiscovered; they inadvertently raise the price of insurance. Hence it is in your best interest to check whether your insurance claims are legitimate and accurate.

There are lots of rules and conditions in an insurance policy, which might require your attention. Don’t become an easy victim to tricksters who are trying to make illegal profits.

In some cases, unscrupulous policyholders, corrupt insurance industry experts, wicked insurance agents, unethical brokers & nefarious business executives or corrupt government officials, and criminally organized networks of shady medical operators and dishonest lawyers are involved in these fraud schemes.

insurance claim

Insurance fraud is a criminal act

Examples & types of Insurance Fraud

Hard insurance fraud is the fabrication of false claims.  In most cases, these claims are totally fake.

Soft insurance fraud can refer to legitimate but exaggerated profit-driven claims.

Car / motor / vehicle insurance fraud – (automotive industry)

  • creating a fake car accident to file a claim is hard insurance fraud
  • staging car accidents
  • tow truck scams
  • emergency brake scams – speed up the car and slam the brakes numerous times until somebody hit the back of the car
  • theft of motorcycles and marine vessels
  • false vehicle theft fraud scheme
  • overstating claim amount – soft insurance fraud – exaggerated damages or expenses – the dishonest policyholder
  • claiming under another driver’s name – faking the driver’s identity
  • car/vehicle theft insurance scam (sales of the vehicle to the workshop. chop it down into parts, report as stolen or hide car)
  • car damage fraud – collision repair fraud (often the workshop or repair shop is involved)
  • health insurance billing fraud – medical care fraud
  • unnecessary medical procedures
  • staged home fires – aron
  • storm fraud – declaration of high damage as compared to real damage
  • water/flooding fraud
  • abandoned house fire – often in an unpopular neighborhood where the property is more difficult to sell
  • fake deaths
  • renter insurance fraud
  • staged burglary, theft, or vandalism
  • home repair fraud
  • workers’ compensation insurance fraud – false statements, concealing information, higher costs
  • lying about the injury…
  • general liability insurance fraud
  • slips and falls fraud
  • property and casualty insurance fraud
  • life insurance fraud
  • fraudulent disability insurance claims
  • disaster-related fraud

Types of Insurance Claims

  • car accidents, traffic accidents – vehicle damage
  • personal injuries
  • workplace injuries
  • property damages
  • burglary and theft
  • stolen cars – vehicle theft
  • arson claim
  • water damage to buildings and contents in it
  • personal injury claims
  • loss of life insurance claim
  • health care & prescription of medicine costs

Red Flags, Signs & Indicators of Fraud Schemes in regards to Insurance

layering via multiple cash payments to different banks to pay for the policy

structuring – making multiple large cash deposits in a very short period of time

check if the insurance agents and companies are licensed operators

Insurance Claim Investigations

  • look for red flags of insurance scams
  • identify which type of insurance fraud scheme
  • investigate the insurance fraud
  • using illegal money to purchase insurance policies
body marking on the pavement of the crime scene

Red flags during an insurance claim investigation

During our insurance fraud investigation, we focus on a lot of aspects in order to evaluate the legitimacy of the claim. Our main question is whether the insurance claim is fraudulent or not. This is done via an in-depth insurance claim investigation.

Activity checks on the claimant

  • surveillance of the home or workplace of the claimant
  • lifestyle check
  • short interview or questions with the community, neighborhood of the claimant
  • check for extra-ordinary things about the claimant
  • financial background check of the claimant
  • is the claimant living in their own home?

Evidence Gathering

  • social media evidence
  • fake documents relating to the claim
  • was incorrect or misleading information put in the insurance application?
  • was relevant information omitted in the insurance transaction or claim?
  • were the rules followed?
  • property insurance fraud investigation
  • lifestyle/background check of the claimant
  • can the claimant afford the items they claim?
  • check the home surrounding to get an idea of the financial situation
  • which hobbies does the claimant have?
  • social media evidence.
  • photos of activities; things owned, travel pictures.
  • find proof of ownership via documents (receipts, manuals, credit card statements).
  • fake documents relating to the claim.
  • check for proof in the trash, dustbins.
  • proper write-up and summary of the interviews.
  • evidence & allegation analysis – (who did what, where, when, how, and why)
  • evidence is required to be authentic (no tampering). the information must be relevant to the case, concrete/factual, and specific.

Investigation of Fraud on Insurance Companies & Report

  • detailed reporting of evidence (focus on facts, not opinions or inferences)
  • report with conclusions & recommendations
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Criminal Investigations

[ Suspicion of criminal activity ] [ Criminal Investigations ] [ Indicators of suspicion ] [ Types of crimes ]
[ Process of a Criminal Investigation ] [ Corporate Crimes ] [ Criminal Corporate Activity ]

Corporate Crime

Corporate Investigations

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Suspicion of criminal activity

Most official criminal investigations can only be conducted by a law enforcement agency or other relevant authorities.

But if the police do not have enough resources to investigate a potentially criminal act, then the help of a private investigator can be called in.

As Private investigators, we will investigate the suspicion of criminal activity, when the rightful authorities have not filed charges or when the crime remained unsolved.

The questions to ask:

  • was a crime committed?
  • if so; who did, what, how, when, where, and why.

Our criminal investigations include:

  • the search for evidence – gathering proof and documentation 
  • conducting interviews with witnesses, coroners, doctors, police, bystanders
  • interrogations are done by the police
  • the evidence is collected and preserved
  • depending on the case other methods of investigation are applied
  • different forensic science investigative technique is used
  • provide support to lawyers to present the evidence in the criminal court of law

 The “indicators of suspicion” in investigations lead to suspects:

The motives to commit a crime:

– money
– revenge
– other reasons

The means to commit a crime:

– tools
– capabilities

The opportunity to commit a crime:

(presence at the crime scene during the time of the offense).

Types of Crimes that we can investigate:

human trafficking
domestic violence
organized crime

The Process of a Criminal Investigation

gather evidence in a legal and professional way
crime scene investigation at the place of the crime
make or gather crime scene photos & crime scene videos

  • gather evidence in a legal and professional way
  • crime scene investigation at the place of the crime
  • make or gather crime scene photos & crime scene videos
  • arrest record & criminal records search on the victims and perpetrators
  • assist in establishing an alibi for innocent people (wrongly accused)
  • fix the refute motive
  • assist in locating the real criminal (who might be on the run or hiding somewhere)
crime scene investigation

Corporate Criminal Investigations & Corporate Crimes

Our AR INTELL Corporate Crime Task Force consists of specialized corporate security professionals. We investigate mostly corporate crimes, torts (wrongful acts or an infringement of certain rights), and different types of contractual breaches.

Corporate crimes & Corporate Investigations mostly refer to:

  • forgery of documents
  • commercial bribery
  • compliance investigations – non-compliance with industry standards
  • property destruction
  • breach of ethical code – unethical behavior
  • infringement of fiduciary & other financial duties.
  • accounting improprieties.
  • violation of company policies.
  • privacy rights issues.
  • reporting fraud
  • internal security & other controls + safeguards
  • information access and information control strategies (CIA principle)
  • insider trading & insider deals
  • cartel forming
  • corporate manslaughter

Criminal Corporate Activity

When you suspect there are criminal corporate activities occurring in your organization or company, then you will need to apply forensic accounting skills. Furthermore, you could learn how to use a polygraph test (lie detector), and understand the correct arrest & other administrative procedures. The use of digital forensics has also become more and more important during the past decades.

Do check our Corporate Fraud Investigations page here.

AR INTELL provides practical and strategic advice to shareholders and corporate executives. Consequently, we can operate at all levels such as company officers, security officers, managers, employees, or staff in financial institutions & multinational corporates.

Over the years we have developed a keen insight into different industries. We offer in-depth local knowledge and insight into regulatory & legal frameworks, international compliance issues, and law enforcement.

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Corporate Intelligence Services & Corporate Investigations

Corporate Investigations

What are corporate intelligence services & investigations?

Corporate Intelligence Services & Investigations will focus on:

How can AR INTELL assist you?

AR INTELL Corporate Intelligence will help you with the protection of your international companies. This is important when you expand your business networks, based on new opportunities. . Typically this will increase your business risk and exposure as an organization.  We will provide you with independent research and risk analysis.

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