What do you think of when you hear the words, insurance fraud? At , we don’t have one description in particular because not only is every case we work on different, but insurance fraud encompasses many different situations. I thought we might take this opportunity to share some of them with you.
Workers compensation fraud (WC) – This is over and above a claim for medical expenses. Claimants file claims alleging a disability that prevents them from working as they did previously. It can be a short-term or long-term claim, or even off and on. Workers compensation fraud investigations saves consumers millions of dollars every year.
Long term disability fraud (LTD) – This has to do with an insurance policy. Someone buys a policy and pays the premium based on continuing their line of employment. Although anyone can purchase such a policy, it is most often acquired by professionals such as doctors and dentists. Disability benefits fraud is not limited to someone hurt on the job.
Auto bodily injury (ABI) fraud – This might be what you thought of when you heard the words, insurance fraud. There are many situations where an ABI claim is at the heart of a personal injury investigation. The one every thinks about is when a vehicle is rear ended and the victim claims they cannot work, or are placed on light duty, because of the injuries from the impact or detonation of the air bag. Sometimes they are even terminated from their employment because they cannot perform the duties of the job. A vehicle accident injury investigation involves much more than the police report. There are many different types under this category, but that is an entire blog post on its own!
Slips and falls (S&F) fraud – These claims are most often in a public place such as a restaurant or store and a claimant alleges a slip and fall accident and they cannot return to work or their lifestyle has changed. This is another category that encompasses a wide variety of fraudulent claims requiring slip and fall injury investigations.
Medical malpractice fraud – These are claims filed against doctors and/or hospitals where the claimant’s work or lifestyle has been negatively impacted as the result of a procedure or treatment, not where the patient has died. A death in a situation like this would probably be under the category of a wrongful death suit. Medical malpractice lawsuits are rampant in the United States and fraud drives up the cost of both insurance and healthcare overall.
Product liability – These are claims or product liability lawsuits against the makers of a product. It covers everything from toys, ladders and car parts to foods, medicines or drinks. Product liability cases can be very complex.
When is called in on all of these situations, our goal is to uncover the truth. It could be that the claim is valid and the client gets confirmation of that. It could be a fraudulent claim and, with the help of insurance fraud investigators, the client has the evidence needed to deny the claim. Fraudulent claims cost consumers millions of dollars every year and the fewer fraudulent claims that are paid means savings for everyone.
-Brenda McGinley, CEO, All in Investigations, All in Investigations