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 for all the premiums people pay. We know it drives up premiums for everyone – even those who never submit a claim. And, we want to cry, “It’s illegal!”
Some claims are simply denied, but more and more people submitting fraudulent claims are being prosecuted. The best weapon insurance carriers have is the claims process with an eye to undertaking insurance fraud investigations when they are warranted.
Take, for example, slip and fall accidents. These accidents usually occur in public places like restaurants and stores. Places where you would think there would be many people to witness the accident. If there are a lack of witnesses in a claim, that’s a red flag – and a trigger for a slip and fall fraud investigation.
Workplace accident investigation is another common request from carriers. It is difficult to prove the presence or severity of back injuries – and the abuse of them! If an adjustor suspects a fraudulent claim, the best chance of uncovering the truth is with an accident investigation of the workplace and surveillance of the claimant. A good investigator is always developing new strategies and techniques to provide documentation and proof of the truth, no matter what the truth is.
-Brenda McGinley, CEO, All in Investigations, All in Investigations