Insurance Fraud Archives - Page 5 of 5

What is Insurance Fraud?

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 [...]

Insurance Fraud Investigators Supply Evidence for Trials

Sometimes when is conducting an investigation on the subject in a potentially fraudulent insurance claim, the result of the evidence can be more than a simple claim denial. Sometimes there is the potential for criminal charges. This is true in many insurance fraud investigations including: Workers compensation fraud investigations Long term disability fraud investigations Auto bodily injury fraud investigations Personal injury fraud investigations or slip and fall fraud investigations Product liability fraud investigations Our investigators know that every case has to be handled as if the data we collect would be used in a court of law. That includes not only videotaped data, computer or cell phone data extracted during a forensics analysis but any other type of information or evidence collected as well. Therefore, [...]

Investigator’s Collection of Data Leads to Confession of Insurance Fraud

When the economy takes a dive or unemployment is high, the incidence of insurance fraud tends to increase as well. It’s not just greed that compels policy holders to commit insurance fraud, it is also desperation. And that is not limited to disability insurance fraud or slip and fall accidents. For example, insurance fraud investigators had a case where a car had caught fire and burned. It was a total loss. Because of a recent change to the policy coverage, a red flag went up to the adjuster and that’s why our investigator was called in. After investigating the claimant, it was uncovered that he had recently lost his job and had taken a lower-paying position with another company. Not too long after that happened, [...]

Insurance Fraud Investigators Throw a Black Flag on Racer’s Claims

Insurance fraud costs insurance companies and, subsequently, their customers, a huge amount of money every year. We believe that insurance companies do want to pay the legitimate claims as much as they want to ferret out the cases where claims are fraudulent. But it is often difficult to tell the difference. Soft tissue injuries are difficult to prove or disprove. Sometimes these are part of slip and fall injury claims, sometimes the underpinning of a personal injury investigation or an auto bodily injury investigation. In this case, it was a both a workers compensation fraud investigation and a long term disability fraud investigation. This memorable case was that of a young man who said he was hurt at work. No one witnessed the accident, but [...]

Insurance Fraud Stacks Deception on Top of Desperation

There are so many different aspects to insurance fraud. Besides fraudulent claims and falsely-acquired settlements, money may be a motivator for other types of insurance fraud. Take, for example the case of a man who lost his job. He had a wife and three children and suddenly found it impossible to find employment. He was desperate so he faked a slip and fall accident at the local mall. He claimed his slip and fall injuries were significant enough to prevent him from working and because it is difficult to prove or disprove soft tissue injuries, the insurance company was reluctant to settle quickly. His situation grew direr because now he was unable to even look for a job because it would show he was faking [...]

Slips and Fall Accidents, Fraud and Videotape

Everyone has heard of these cases, we have seen lots of them here at : the ones where a person (the claimant) has slipped or fallen and claims to have injured themselves in a restaurant or store. What you might not know is that there is a huge contingent of repeat claimants. One of the first things an insurance company does when it receives a claim is to run the claimant through an industry database of all insurance claims filed. Only people in the insurance industry have access to that database and when a person comes up as a repeat or a serial claimant that throws up a huge red flag. Many insurance companies and companies who are self-insured have special investigative units (SIUs), but [...]

Medical Provider Fraud Surprises Innocent Patients

You might be surprised to learn that not all insurance fraud is uncovered because of a personal injury investigation, workers compensation fraud investigation, product liability investigation or a long term disability insurance fraud investigation. No, it’s not always the “patient” who is being investigated. Sometimes it is the medical care provider! Not every doctor, physical therapist or chiropractor is committing medical insurance fraud, but some are. Investigators were called in regarding insurance claims coming in from a specific chiropractor. The insurance company noticed that the number of claims had significantly increased from this particular service provider and the services were long-term and fairly extensive. It was the change in the claim history and types of claims that triggered one of those “red flags” for adjusters. [...]

Fishing For Long Term Disability Insurance Fraud

Long term disability (LTD) cases are not decided and then set aside. In many cases, LTD claims are reviewed, especially if an investigation was completed previously but was not conclusive one way or another. Such a case came into an investigator. In this situation, the claimant had been receiving LTD benefits for several years when an adjuster reviewed the file and decided that it was time to take another look. The claimant was a man who had physical restrictions regarding the number of pounds he could lift and the amount of physical activity he could safely engage in at any time. A previous investigation had not been absolutely conclusive that he was committing long term disability insurance fraud, but the adjuster had a feeling something [...]

Full Service Investigators Bring It All to Insurance Fraud Cases

Part of the reason why insurance companies, attorneys and self-insured companies hire a private investigator like is because we can uncover the truth in a wide variety of situations. For example, in one case where a car was allegedly stolen and recovered completely burned out, the insurance company asked us to investigate the owner. The insurance company did not share their file, which is not uncommon, nor did they share why they were asking us to investigate. We were provided with information about the claimant and simply were asked if we could investigate to see if he had been involved in burning the car. After getting the details of the location where the car was burned and the location of the claimant’s home and work, [...]