insurance fraud investigation Archives - Page 2 of 2

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 [...]

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. [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]