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