Insurance Fraud Investigations

What is an Insurance Fraud Investigation?

An insurance fraud investigation is a type of fraud investigation that centers around attempts to benfit from decietful claims. Seeking compensation for false or inflated claims is illegal, dangerous, and raises the price of insurance for everyone. According to the Coalition Against Insurance Fraud, an estimated $80 billion is paid out annually in fraudulent insurance claims. This leads to the average household paying around $950 each year in higher premiums. In addition, being held liable in a staged accident can increase your risk of being sued. The prevelence of this type of fraud has resulted in insurance companies acting with caution when paying claims, meaning you may need professional help when making your claim. An insurance fraud investigation aids by revealing false claims. Don’t let your insurance premiums be a waste of money; use a private investigator to safeguard your insurance privileges.

Types of Insurance Fraud Investigations

This investigation determines whether someone is getting paid for health care they are not receiving or is filing health care claims that are not valid or needed. Investigators will search billing records to make sure that doctors and patients are not colluding to commit fraud.

Some criminals stage accidents in which they purposely collide with another car, then accuse the other driver of fault in order to file claims. Others attempt vehicle theft fraud, trying to get money for a car that is not stolen.

With home insurance fraud, investigators discover disaster fraud, including false damage claims. They will often determine if the claimant upgraded their coverage right before the claim was filed. Investigators will also verify the validity of property damage claims.

This type of investigation uncovers cases of people who claim too much life insurance or claim it while still alive. Investigators also verify the existence of those claiming life insurance.

When workers claim compensation for an injury, a workers compensation investigation will confirm the severity of the injury and whether the accident occurred while the person was working.

Bad practices can also occur within the insurance companies themselves. If an insurance company takes money but does not sufficiently compensate, an investigator can aid with resulting court cases. 

How is an Insurance Fraud Investigation Conducted?

There are several methods used to find information in an insurance fraud investigation. Most are used to determine whether claims are true or false. Here are a few commonly used techniques:

  • Surveillance to verify the claim
  • Medical reports/history search
  • Previous claims/accidents search
  • Insurance coverage analysis
  • Witness interviews
  • Physician’s billing search and analysis
  • Claimant background check

Isn't an Insurance Investigation just for Insurance Companies?

Absolutely not. When people seek to make fraudulent insurance claims, they often attempt to make claims from the estate of someone else they’ve implicated in the accident. For example, if someone sideswipes your car and then claims you’re at fault, not only will your premiums increase, but the criminal may target you to receive additional money. A fraud insurance investigation by a professional investigator can uncover schemes and save you the hassle and costs of a court case. It can also help keep your insurance costs down.

If you have been accused of insurance fraud, a qualified insurance investigator can help clear your name by gathering evidence of the injuries or damage. This can help ensure that your insurance company pays you on time and pays you the full amount to which you are entitled.

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