slip and fall fraud investigation

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 [...]

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 [...]

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