An insurance fraud investigation is a type of fraud investigation that centers around attempts to benefit from deceitful claims. Seeking compensation for false or inflated claims is illegal, dangerous and raises the price of insurance for everyone. According to the Coalition Against Insurance Fraud, an estimated $80 billion is paid out annually in fraudulent insurance claims. This leads to the average household paying around $950 each year in higher premiums. In addition, being held liable in a staged accident can increase your risk of being sued.
The prevalence of this type of fraud has resulted in insurance companies acting with caution when paying claims, meaning you may need professional help when making your claim. An insurance fraud investigation aids by revealing false claims. Don’t let your insurance premiums be a waste of money; use an investigator to safeguard your insurance privileges.
Types of Insurance Fraud Investigations
Health Insurance – This investigation determines whether someone is getting paid for healthcare they are not receiving or is filing healthcare claims that are not valid or needed. Investigators will search billing records to make sure that doctors and patients are not colluding to commit fraud.
Car Insurance – Some criminals stage accidents in which they purposely collide with another car, and then accuse the other driver of fault in order to file claims. Others attempt vehicle theft fraud, trying to get money for a car that is not stolen.
Home Insurance – With home insurance fraud, investigators discover disaster fraud, including false damage claims. They will often determine if the claimant upgraded their coverage right before the claim was filed. Investigators will also verify the validity of property damage claims.
Life Insurance – This type of investigation uncovers cases of people who claim too much life insurance or claim it while still alive. Investigators also verify the existence of those claiming life insurance.
Workers Compensation Insurance – When workers claim compensation for an injury, a worker’s compensation investigation will confirm the severity of the injury and whether the accident occurred while the person was working.
Insurance Company Fraud – Bad practices also can occur within the insurance companies themselves. If an insurance company takes money but does not sufficiently compensate, an investigator can aid with resulting court cases.
There are several methods used to find information in an insurance fraud investigation. Most are used to determine whether claims are true or false. Here are a few commonly used techniques:
Surveillance to verify the claim
Medical reports/history search
Previous claims/accidents search
Insurance coverage analysis
Physician’s billing search and analysis
Claimant background check
Call Crucible today at 201-252-2532 for a free, no-obligation assessment of the matter under review to find out if a professional investigation will provide details and clarity to assist in making the appropriate determination.