Insurance companies in the United States pay billions of dollars in claims annually. Unfortunately, a good number of these claims are stage managed which inhibits the industry’s growth potential. Insurance fraud is not a reserved for notorious financial criminals as a considerable number of citizens are engaging in the fake claims because most of them think the practice is guilt victimless.
A recent survey shows that more than 20% of Americans perceive committing insurance fraud as okay —it’s a retrogressive practice that if not well regulated could cripple the insurance industry rendering many jobless while making these companies financially unsustainable.
Private investigators continue to play an important role in fraud cases of insurance claims by deploying various methods to counter the menace in a bid to streamline the industry. Medical accidents and home insurance claims top the list as the most commonly used channels by fraudsters to defraud insurance companies.
The National Insurance Crime Bureau which is the agency in charge of investigating and mitigating illegal insurance claims and keeps records of most insurance settlements for future the reference in case a fraud matter is referred to them for investigation. Insurance companies have a right to initiate an investigation on suspicious claims should they have reasonable doubts that the claims could be dishonest and untrue.
Research shows that human beings follow a certain routine in their day to day life and surprisingly, genuine insurance claims follow a certain pattern which is predictable and consistent. Fraudsters usually manifest irregular patterns in the way they carry themselves before, during and after the accident and this is where a private investigator could be engaged by insurance companies to prove damages before settling the claims. Repeated history of similar claims is a good reason to question authenticity of the claims as over 35% of such cases have turned out to be fraud.
The following are some of the red flags that could lead to an investigation, keep in mind that these are only signs and do not always mean gulit:
• The psychological state of the claimant during the claims process. Are they too nervous or too confident with inconsistent body language and conflicting statements?
• The authenticity of the receipts submitted for claims should also be scrutinized.
• Increasing coverage right before the accident as if they were expecting something would go wrong.
• Some workers are very calculative with medical compensation where they initiate a claim right before their work contract ends. Such claims together with habitual claiming of work-related compensation should be investigated to ascertain their legitimacy.
• Inappropriate billing of medical treatment is another loophole utilized by fraudsters where they manipulate charges higher or seek unnecessary
medical procedures to make the situation look very critical while in the real sense it’s not the case.
Not all illegal claims are initiated by claimants. Rogue doctors and lawyers have been found at the center of the controversy where claimants are ill advised to seek higher compensation than what they deserve—which is not only illegal but also unethical.
Over 30,000 cases of fake medical insurance settlements are filed in the United States annually, a clear indication that the sector is incurring unnecessary legal fees which could be avoided if services of private investigators would be utilized—Insurance companies could avoid paying these fake claims and unnecessary legal charges thus saving the industry the much needed resources for growth.
Are you an insurance agency or working in the insurance industry and you would like to know what really transpired before you settle the insurance claims? Would you like to be furnished with relevant facts for a legal suit against a fake insurance claims, and you don’t know where to begin?
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Workers Compensation Fraud - Life Insurance Fraud - Health Care Insurance Fraud