Insurance Fraud Investigations

Insurance Fraud

Insurance Claims

Insurance

Investigations

Illegitimate insurance claims

Illegitimate insurance claims cost billions yearly. Some people still think that insurance fraud is a victimless crime. Insurance fraud is a criminal act with the intent to intent to deceive & the wish to get the insurance company to pay out more money.

Take note however that these crimes are not without victims or consequences. Instead, we are all paying the price in the form of higher insurance costs. Because all these false or unfounded insurance claims might require an investigation to verify if they are legit.

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

There are lots of rules and conditions in the 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.

Examples & types of Insurance Fraud

Hard insurance fraud = fabrication of claims.  Mostly totally fake.
Soft insurance fraud = legit, but exaggerated profit-driven claims

  • car / motor / vehicle insurance fraud
    • creating a fake car accident to file a claim – hard insurance fraud – staging car accidents
    • tow truck scams
    • emergency brake scams – speed up car and slam the brakes numerous times until somebody hit the back of car
    • overstating claim amount – soft insurance fraud – exaggerated damages or expenses – dishonest policyholder
    • claiming under other driver’s name – faking the driver’s identity
  • car/vehicle theft insurance scam (sales of vehicle to work shop. chop it down into parts, report as stolen or hide car)
  • theft of motorcycles and marine vessels
  • false vehicle theft fraud scheme
  • car damage fraud – collision repair fraud (often the work shop 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 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, lies 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 – hehicle 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 Insurance Fraud Schemes

  • layering – using multiple cash payments 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 – Insurance Claim Investigations

  • look for the red flags of insurance scams
  • identify which type of insurance fraud scheme
  • investigate the insurance fraud
  • using illegal money to purchase insurance policies

During our insurance fraud investigation, we check a lot of things to evaluate the legitimacy of the claim. The 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, neighborhoud 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 false information put an insurance application?
  • was false/misleading information given during the application?
  • was important information omitted in the insurance transaction or claim?
  • were the rules followed?
  • property insurance fraud investigation
  • lifestyle 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 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), relevant to the case, concrete/factual and specific

Insurance Fraud Report

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