What is an Insurance Fraud Investigation?

    An insurance fraud investigation is a fraud investigation that centres around fraudulent attempts to collect based on excessive or false claims.

    Methods of defrauding insurance companies are manifold, as are the means of investigating them. As a crime, however, evidence shows that insurance fraud in both first-world and emerging third-world nations is increasing, with many governments running public awareness campaigns to deter potential fraudsters and appeal to the public to report any suspicious claims.

    One of the most common forms of insurance fraud is the exaggeration of injuries. Because many injuries can be exceptionally difficult to quantify (for example, psychological injuries or physical injuries such as whiplash), investigators will often seek to establish that what the claimant claims is true (for example, if a claimant states he or she cannot work) and that there are no obvious discrepancies in the symptoms claimed (very often examined in conjunction with medical staff). Surveillance is often employed in such circumstances to verify the claim.

    Another form of lesser-known fraud is that of claiming on an insurance policy for injuries sustained before the policy came into effect. For example, in a road accident, a person may claim to have sustained a debilitating back injury. On investigation, however, it transpires that the injury had been sustained in an incident some months or even years before. Very often insurance companies and investigators will study medical reports and history to eliminate this possibility, as well as searching for evidence of previous claims or accidents.

    There are also many forms of fraud involving property, for example when a person with valuable assets (property, for example) deliberately destroys them, often through arson, with the intention of then claiming the value back through insurance. Another form would be an art collector insurance a high-value piece and then having it 'stolen' - claiming the money for himself and keeping the art piece in the process.

    Fraudulent insurance claims affect everyone, as these false insurance claims cost the average household more each year in higher premiums. Plus, false insurance claims can mean that you are held liable in a staged accident and increase your risk of being sued. The high instance of insurance fraud has meant that insurance companies are far more cautious when paying claims, which may mean that you need professional help to make your claim. An insurance fraud investigation is performed to find out if false claims are being submitted. Insurance fraud investigations are usually conducted when an adjuster has doubts about the case that they are evaluating. Don't let your insurance premiums be a waste of money. Use a private investigator to safeguard your insurance privileges.

    What Kinds of Insurance Fraud are Investigated?

    In general terms, an insurance investigator tries to determine whether someone has filed a false insurance claim. There are many types of insurance investigations, including:

    • Health insurance fraud investigation. This investigation tries to determine whether someone is getting paid for health care that they are not receiving or is filing health care claims and requests that are not valid or needed. Insurance claims investigators will search billing records and make sure that doctors and patients are not colluding to commit fraud.
    • Car insurance fraud investigation. Some criminals stage accidents, in which they purposely collide with another car and then try to accuse the other driver of an accident in order to file claims. Some criminals attempt vehicle theft fraud, trying to get money for a car which was not, in fact, stolen. Insurance fraud investigators uncover these schemes.
    • Home insurance fraud investigation. In this type of insurance investigation, investigators discover disaster fraud, which includes false claims of damage. Investigators will often try to find out if the claimant has upgraded their coverage before the claim was filed. They also investigate property fraud to find evidence against those who make false claims about property damage.
    • Life insurance fraud investigation. Investigators work to uncover cases of people who claim life insurance while still alive or those who claim too much in life insurance. Investigators also verify the existence of an individual who has life insurance being collected on them.
    • Workers compensation fraud investigation. Insurance investigators work to find evidence of workers who claim compensation when not as injured as they claim. Investigators will verify the severity of the injury and whether the injury occurred while the person was working.
    • Insurance company investigation. Investigators also work to uncover evidence of bad business practices at insurance companies. If an insurance company takes your money but does not compensate you as promised, a professional investigator can help you make your case in court.

    Isn't an Insurance Investigation Just for Insurance Companies?

    Absolutely not. When people seek to make fraudulent insurance claims, they also often attempt to make claims from the estate of someone else they've implicated in the accident. For example, if someone sideswipes your car and then claims you're at fault for the accident, not only will your premiums increase, but the criminal may actually target you to get additional money. A fraud insurance investigation by a professional investigator can uncover the scheme and can save you the hassle and costs of a court case. It can also help you keep your insurance costs down.

    If you yourself have been accused of insurance fraud, a qualified insurance investigator can help clear your name by gathering evidence of the injuries or damage of sustained. This can help ensure that your insurance company pays you on time and pays you the full amount to which were entitled.

    At Rick Crouch & Associates we have a team of professional insurance investigators dedicated to insurance fraud investigations.