fraud investigation Archives - All in Investigations

Insurance Fraud Covers More Than a Falsified Slip and Fall Claim

We have all heard the horror stories about employees who scam the system and cost their employer lots of money by filing false claims and committing workers compensation fraud. But another very real issue involves dishonest business owners who scam coverage providers. And so, when insurance companies contact about insurance fraud, we move swiftly to resolve the problems. Because, for every day that a dishonest business owner gets away with this crime, everyone else is at risk, whether we're talking about financial loss for the insurance carrier or benefit loss for innocent employees. Crooked business owners illegally reduce the owed amounts of workman's compensation premiums by hiding behind fake companies. This practice can be difficult to discover since the business may even provide bogus accounting [...]

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 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 [...]

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 [...]