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Understanding Insurance Fraud
Insurance fraud is the second costliest white-collar crime in
America, after tax evasion. It is estimated that $80 billion is
paid out each year in fraudulent insurance claims. It is
estimated by the Coalition Against Insurance Fraud that the
average American household pays over $950 a year in additional
premiums to cover the cost of insurance fraud. According to
industry estimates, healthcare fraud alone costs Americans $54
billion a year.
The Insurance Research Council revealed some alarming
information obtained from a recent survey regarding types of
insurance crime that is considered "acceptable" by an unusually
high percentage of the public. These types of insurance fraud
include the following followed by the percentage of those
surveyed who felt that it was acceptable:
* Increasing the claim to cover the deductible - 40%
* Increasing the claim to cover the premiums paid - 36%
* Including defective or obsolete appliances on a lightning
claim - 29%
* Listing adults as main driver of a car being driven by an
under age driver - 20% * Omitting accidents/tickets from an
insurance application - 14% * Continuing medical treatment to
increase the value of a claim - 11% * Pretending a hit-and-run
accident occurred to submit a claim - 7% * Abandoning a car and
reporting it stolen to the insurance company - 6% * Reporting an
injury at home as work related in order to collect workers'
compensation benefits - 10% * Cooperating with lawyers, doctors
or chiropractors to file false or exaggerated workers'
compensation claims to get money from insurers - 17%
Insurance fraud typically consists of the following types or
instruments of fraud:
* Workers' compensation premium fraud occurs when an employer
provides false information in order to obtain a lower insurance
rating. * Workers' compensation fraud occurs when an employee
files an inflated or false injury claim in order to receive
benefits or increase benefits. * Staged accident fraud occurs
when a person intentionally causes or is involved in an
accident, or walks in and reports an accident in order to
compensation or false or intentional damages and injuries. This
could include automobiles or fake "slip and fall" claims. *
Property fraud is the falsification or inflation of a claim for
the loss of personal or commercial property in order to obtain
benefits. This includes losses due to the theft, disaster, or
arson of insured property and vehicles. * Benefits fraud occurs
when an uninsured person receives benefits reserved for an
insured person as it relates to his or her policy. A typical
example of benefits fraud includes a non-covered dependant
receiving medical or dental treatment by using a parent's name
or identity. Similarly, we have seen friends and roommates
commit benefits fraud as well.
There are certainly many other types of insurance fraud, but
these are clearly the most prevalant.
The first step in uncovering insurance fraud is to identify some
of the most ordinary clues, or "red flags," that signal possible
dishonesty in an insurance claim. These red flags are facts or
information that will require further investigation into the
nature of the claim.
Once the "red flags" are identified, it is paramount that a
complete investigation then be conducted! A written or recorded
statement locks the claimant into a set of facts that cannot be
easily changed, especially when confronted by a contradictory
video or photographic surveillance product. For this reason
statements from all parties and witnesses involved in an insured
loss should be the very first entries in a claims file.
About the author:
L. Scott Harrell is the author of Statements, Lies and
Videotape: An Investigator's Guide to Insurance Claim
Investigations, a manual which completely and accurately
describes proven investigative methods developed from 14 years
of experience as a private investigator and principal of
CompassPoint Investigations.
More information regarding CompassPoint Investigations can be
found via his website: http://www.CompassPointPI.com
L. Scott Harrell
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