Ways Insurance Agents Spot Fraudulent Claims

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Insurance fraud is becoming an increasingly common problem in the United States, and it can have serious legal implications as a legal malpractice lawyer can attest. Perpetrators continue to come up with new and more effective ways to trick insurance companies into accepting their claims and insurers can end up providing compensation for events or injuries that never happened. Fortunately, insurance companies have devised several ways to ensure the legitimacy of a claim and expose fraud. Here we have shared 10 most effective ways for spotting a fraudulent claim.

1. Fraud Involving Professionals

Oftentimes, victims fake or exaggerate their injuries to get more compensation. This is especially common in vehicles crashes, where it is hard to determine the extent of an injury. Typically, professionals are also involved in such fraudulent practices, such as attorneys, medical providers, and others, and work with victims to scam insurance companies to get a cut in profits.

2.    Including Old damage in a New Claim

Some people tend to include old damage, such as scratches and dents,that were already present on the car before the accident when filing a claim. However, insurance companies can easily make out the difference between old and new damage, and reduce the amount of compensation or deny it altogether.

3.    History of Claims

If a claimant has filed a lot of claims in the past, it is a major red flag that they are trying to scam the insurance company. However, insurance companies keep a strict record of claims with in-depth detail, enabling them to read any patterns and determine whether the claim is legit.

4.    Carefully Studying Evidence

Pictures and videos make for solid pieces of evidence in insurance claims. These can be used to check the before and after condition of the damaged property and how the claimant reacted to the situation to determine whether to accept or deny a claim.

5.    Checking the Claim with NCIB Suspicious Loss Indicators

Insurance companies continually refers to 23 suspicious loss indicators – a list created by the National Insurance Crime Bureau (NCIB) to prevent insurance fraud. The good part is that a majority of the perpetrators don’t even know this kind of list exists, leading them to make mistakes that can be easily spotted by insurance companies.

6.    Adding more Victims

Some claimants try to establish that there were more people in the car at the time of accident to increase the amount of compensation. However, the police and investigators conduct thorough investigations of the accident scene, and make a police report comprised of comprehensive details, including the number of victims. When the victim’s testimony contradicts with the police report, it is a sure sign of insurance fraud.

7.    Special Investigation Units

Some insurance companies have special investigation units that are trained specifically to conduct in-depth investigations of claims. These units generally have personnel with experience in detective work, police investigations, medical examinations, and others. With the help of checks and tests, they can easily spot cases of insurance fraud.

8.    Social Media

Social media is a public platform where anyone can see what you have been doing. Insurance companies check social media activity of claimants to make sure that they are not faking their injuries or making a false claim.

9.    Cross-Checking Medical Bills

Another popular scam is tampering with medical bills to increase the amount of compensation. However, insurance companies have access to complex computer systems that enable cross-checking suspicious billing patterns from medical establishments and physicians.

10. Eye Witness Testimonies

Eye witnesses are generally neutral and give accurate testimonies, as they are unconnected to the accident or the victim. Witness statements can be used to determine whether the claimant is telling the truth or trying to change the accident details to enhance their claim.

Fraud, in any form, is a serious crime. Insurance fraud may land you some extra money from your claim, but the risk and harsh penalties associated with the practice greatly outweigh the little benefit you may get.