Insurance Fraud Archives - Page 4 of 5

Don’t Become a Victim of Vehicle Accident Insurance Fraud

It was reported at Bankrate.com that fraud is an element in one out of every 3 auto insurance claims in New York City! That is incredible and officials say that this fraud adds an estimated $241 million to premiums every year. New York City is not alone. The article reported that the top five states for auto insurance fraud are California, Florida, Texas, New York and Maryland. Is it no wonder that insurance company claims adjusters are always looking for red flags? When there is something that makes the adjuster question the legitimacy of a claim, they often call an investigator in on the case. A vehicle accident investigation can result in determining one of the following staged crashes has occurred: Wave down: requires two [...]

Car Arson – Insurance Fraud or Criminal Case? Could be Both

You would think calls to regarding car arson would be from an insurance company representative saying that arson was expected regarding a claim. But experienced investigators never jump to a conclusion – they listen to the whole story before moving forward. And since investigates so many different cases, they know there are many directions a call can go. This particular story began with the attorney representing the accused. Sure enough, the insurance company wanted to deny a claim because of arson and the municipal police investigating were supporting the District Attorney’s decision to prosecute the car owner for arson – with insurance fraud charges on top of that. There was no need to be concerned about getting the accused man’s cell phone, he was happy [...]

Vehicle Accident Investigation Reveals After-the-Fact Insurance

People buy insurance for all those unexpected happenings in life. But not all people have insurance in place when those events occur. And that can lead to problems – for a lot of people. The Natchez Democrat told the story of a man in Mississippi found himself in that latter group. He did not have insurance and hit a deer. He called a friend who encouraged him to get insurance immediately – and (here’s the rub) then claim the accident occurred after the policy was issued. So, that’s what he did. After getting the policy, the claim was submitted, which prompted a vehicle accident investigation. Sometimes it is not clear when gets called into a case whether it includes auto bodily injuries. But because our [...]

Insurance Fraud Investigations Also Uncover Forgery

In the course of insurance fraud investigation, Internal Investigators has uncovered a trend that accompanies some claims – and that is forgery. Product liability cases can involve anything from a vehicle, to a food product, furniture, building materials and everything in between. When a claim is made about a product that might require relocating or acquiring rental cars, campers or the like, fraud and forgery can go hand-in-hand. Case in point is a pending case in New England. A man has been charged with insurance fraud and forgery in connection with a claim made to his insurance company. There was a problem with his vehicle and he said it could not be driven. He submitted more than $500 worth of receipts for a rental vehicle. [...]

Personal Injury Investigation Reveals Fake Job and Fake Wages

When insurance claims are approved and benefits begin, that doesn’t mean the case is closed. Especially if the insurance claims adjuster sees one or more red flags. In that case, an insurance company may hire private insurance fraud investigators for a brief surveillance – maybe a day or two. In that short time frame, the investigator might not uncover any evidence of fraud. However, many adjusters make a note to revisit the case for a review. This happens often in suspected workers’ compensation fraud, disability insurance fraud or other sorts of situations that result in personal injury investigations. And what is uncovered in a review can be more intriguing than a made-for-TV movie. Just this month The Daily Southerner reported on a couple in Tarboro, [...]

Slip and Fall Accident Investigation – We Do It All!

One of the purposes of the blog is to educate our customers and clients – and prospective clients. We do that by staying abreast of news and sharing that and insights with you. Therefore, when we discovered that many insurance companies and underwriting associations are educating their members in ways to detect fraud, we wanted to share that with you. It’s not uncommon to find a slip and fall injury case study outlining specifics of a case in an article in members’ publications or in reports online. The articles are very clear about the elements that are “of concern.” When we undertake insurance fraud investigations, we often are confronted with the attitude that fraudulent claims are really no big deal – after all, it’s payback [...]

Workers’ Compensation Fraud Investigation Reveals Complex Web

works with workers’ compensation insurance providers investigating workers’ compensation fraud. Through investigative techniques and surveillance, we often can uncover the truth about claimants and their activities. But that’s not all. The company being insured can come under question. Are the employees and wages being accurately reported? Are claims being processed in accordance with the law? A workers’ compensation investigation can also entail investigation into the medical services providers. In fact, sometimes the investigation is centered on the medical services providers. If that is the case, the workers’ comp fraud costs to the insurance carrier usually increases substantially. That is because the fraud can include many patients and many different insurance carriers. One chiropractor in Pennsylvania was charged with filing fraudulent claims to several different insurance [...]

Medical Service Providers Caught in Insurance Fraud Investigation

If you want to understand why insurance companies hire private insurance fraud investigators, consider this quote from the NorthJersey.com, the online home of The Record: "Three former chiropractors from Bergen and Passaic counties were sentenced to five years of probation Monday for setting up a fraudulent practice in Paterson and cheating more than 30 insurance companies out of what prosecutors say was millions.” Yes, you read that correctly – MILLIONS! The three medical services providers received sentences and were ordered to pay a total of $250,000 in restitution. But they cost the insurance companies millions of dollars, in fact it is reported that the three generated $2.8 million in fraudulent billings. When is called into a case like this, we know that it often results [...]

Workers Compensation Fraud Investigation Leads to Surprises

A recent California case reported in the Los Angeles Daily News proves that workers’ compensation fraud is not just about employees and their claims. No, in this case, the employer was revealed to be the perpetrator of workers’ comp fraud. The employer was found guilty of workers’ compensation fraud and sentenced to 29 days in jail, three years of probation and ordered to pay $110,381 in restitution for failing to accurately report employee wages. He was understating wages in order to pay a lower premium for workers’ compensation insurance. He also filed at least one claim during the time in question for an employee’s injury without paying insurance on the employee’s wages. is familiar with the workers’ compensation fraud investigation everyone thinks about – where [...]

Staged Accidents Cost Big Money in Insurance Fraud

is seeing a growing incidence of insurance fraud, specifically, in auto bodily injury (ABI) cases. Part of the increase in claims is due to contrived accidents, which are also called set up auto accidents or staged accidents. These accidents involve a large number of people – both “victims” and service providers (car repairs, doctors, chiropractors) – and cost insurance consumers billions of dollars in increased premiums. The way it works is this: Several vehicles, say up to 10, are hired. The drivers of the vehicles and their passengers are paid a stated amount (could be $1,000 - $2,000) to participate. They drive in a pack on the highway, box in a car and cause an accident. Often that is stopping suddenly in front of the [...]