What Is Insurance Fraud?

 

An Insurance Fraud Investigation is a type of fraud investigation that revolves around catching criminals attempting to benefit from fraudulent, deceitful and/or exaggerated claims. Yes, we called the individuals “criminals” because these actions are illegal and a violation of law.

 

These fraudulent claims are detrimental to everyone because the end result is a higher price of insurance nationally. Verified studies have shown that $300 billion is paid out annually in fraudulent insurance claims. These huge pay-outs trickle down to the average insurance consumer to the amount of $400 - $700 a year in increased insurance premiums. Being held liable in a false accident can open you up to the risk of being sued. This is a lose-lose situation for innocent people that work hard and have not done anything wrong and also an unnecessary financial burden on insurance companies.

 

Another downside to these fraudulent claims is that insurance companies are on such guard for false claims that it makes it extremely difficult for those filing legitimate claims to get the assistance they need and deserve. Real victims are forced to hire an attorney to fight for benefits they actually need but are being rejected by insurance companies due to the suspicion of fraud.  

 

 

What Is Soft Insurance Fraud?

 

Soft Insurance Fraud is a fraud of opportunity. It is characterized by being unplanned and arises when the opportunity suddenly presents itself. It is the more prevalent form of fraud. An average example of this is when a person legitimately gets into a car accident then exaggerates the extent of their injuries. This exaggeration results in the person getting a larger settlement than if they would have told the truth about their injuries.

 

 

What Is Hard Insurance Fraud?

 

Hard Insurance Fraud is a fraud that is meticulously planned in advance. These schemes take time, research and sometimes multiple people to be successful in their efforts. An example of this would be intentionally slamming on the brakes of their car to cause someone to run into the back of them due to not stopping quickly enough. Another example would be faking their own death in order to collect the life insurance benefit.

 

 

What Type Of Insurance Fraud Investigations Does Investigate NC Specialize In:

 

• Car Insurance Fraud – In this insurance fraud scheme criminals purposely collide with another car then put fault on the other party. They greatly exaggerate injuries claiming they have neck pain, back pain and headaches which cause them to lose sleep. These claims often are accompanied by their claim they can no longer work or enjoy their previous quality of life.

• Workers Compensation Insurance Fraud – Workers will often stage a fake accident while at their place of employment then sit home while collecting a full paycheck. If the accident isn’t staged at work, then it happened while off the job. The resulting injury is then reported the next day while on the clock as if it originated at work.

• Accident Insurance Fraud – The most prevalent example of this type of fraud is the classic “slip and fall accident”. The criminal will pour water on the floor, then perform a staged fall or buckle the edge of a rug and lie next to it as though a fall has occurred. The resulting business or property owner is held liable for the negligence of providing a safe environment for its patrons. All the while, the criminal is at home relaxing and making false claims of pain, suffering and the inability to work.

 

 

To Investigate Insurance Fraud Claims We Utilize The Following Investigative Techniques:

 

• Perform criminal record checks

• Interview co-workers, friends, associates, neighbors, customers or any potential witnesses to the event

• Monitor social media profiles as well as any professional profiles and business activities

• Perform Surveillance to gather video and photograph evidence

• Review medical records to identity pre-existing conditions, injuries or symptoms documented before the incident

• Insurance coverage analysis to see what additional policies and benefits the criminal could acquire

• Physicians billing search and analysis

• Examine public records and information gathering databases

 

 

Are Insurance Fraud Investigations Just For Insurance Companies and Businesses?

 

Absolutely Not. Anyone can be a victim of insurance fraud which causes insurance fraud investigations to be sought by anyone. Criminals will often target private citizens or the estate of someone they’ve implicated in an accident. Someone could easily stage a fake slip and fall at your personal residence, accuse you of being at fault and file a fraudulent claim against your personal homeowner’s insurance. If the criminal is successful, then your insurance company will have to pay this person for medical bills, time out from work, pain and suffering and this could lead to a separate civil lawsuit in court. Situations like these warrant the hiring of a Private Investigator to look into the matter.

 

If the roles are reversed and you are accused of insurance fraud, a Private Investigator can assist in clearing your name by gathering facts about the case, your injuries and dissuading the false claims of the insurance company, police or other party. This can ensure you receive the benefits you deserve and get paid on time without delay due to false accusations.

 

 

I believe I Am A Victim Of Insurance Fraud. What Should I Do?

 

Matters like these can be very scary. Letters from law offices and documents from insurance companies can be extremely intimidating. If you suspect you are being targeted for insurance fraud, it doesn’t matter if you’re a business, insurance company or citizen, call a Private Detective In Raleigh NC at Investigate NC so we can help.