INVESTIGATING FRAUD
When it involves fraud many of us think about insurance companies. But insurance fraud is also a deliberate deception perpetrated against or by an underwriter or agent for the aim of monetary gain. Fraud could even be committed at different points within the transaction by applicants, policyholders, third-party claimants, or professionals who provide services to claimants. Insurance agents and company employees may additionally commit insurance fraud. Most common frauds are inflating claims, misrepresenting facts on an insurance application, staging accidents, and submitting claims for injuries or damage that never occurred.
STATISTICS
Fraudulent claims total a minimum of $80 billion annually within the United States.
Property-casualty fraud steals over $30 billion annually..
Insurers disburse up to 10% of their claims cost on fraudulent claims annually.
10% of business owners are concerned that their employees will be involved in fraudelent work-related injuries.
The total cost of insurance fraud (non-health insurance) is estimated to be over $40 billion annually.
Insurance fraud costs the standard U.S. family between $400 and $700 once a year within the fashion of increased premiums.
All of this happens although 95% of insurance companies use anti-fraud technology.
WORKERS COMPENSATION INVESTIGATIONS
The workers’ compensation insurance fraud costs insurers and employers $6 billion a year according to the Coalition Against Insurance Fraud (CAIF) estimates.
CLAIMANT FRAUD
Examples of claimant fraud include over-utilizing treatment to stay receiving lost income (indemnity) benefits, exaggeration of symptoms, working while allegedly disabled and not reporting income, claiming a job-related injury that never happened, or claiming a non-work-related injury as a work-related injury.
PREMIUM FRAUD
Employers who misrepresent their payroll or the kind of labor applied by their workers to pay lower premiums to commit worker’s compensation fraud. Some employers also apply for coverage under different names to attempt to recover monies owed on previous policies or to avoid detection of their true claim records.
GENERAL / AUTO LIABILITY INVESTIGATIONS
Auto insurance fraud can be as small as misrepresenting facts on insurance applications and inflating insurance claims or as big as submitting claim forms for injuries or damage that never occurred, staging accidents, and false reports of stolen vehicles.
Personal-lines auto insurers lose a minimum of $29 billion a year in premium leakage. This includes wrong or missing information that drivers provide insurers, which inaccurately lowers auto premiums.
Fraudulent claims mostly involved chiropractic treatments and alternative treatments. Likewise, auto injury claim fraud and abuse accounted for between 13% and 17% of total payments for auto injury coverages.
No-fault scams cost the common two-car family in Florida $100 in increased auto premiums.
21% of bodily injury claims and 18% of non-public injury protection claims that ended with payment in 2012 appeared fraudulent.
The average two-car family in Florida pays nearly $100 more in auto premiums due to no-fault scams.
In 2011 in Florida alone, no-fault fraud and abuse cost consumers and insurers estimated $658 million.
HOW WE CAN HELP IN INSURANCE FRAUD INVESTIGATION
Lex Florida Investigations provides special investigations and surveillance services for insurance companies and private businesses within the State of Florida. Our experienced investigators are able to assist in the subsequent areas:
SURVEILLANCE
Private investigators utilize surveillance in the attempt to validate whether a claimant’s stated shape is true and verifiable. An investigator will monitor a subject’s daily activities, movements, and interactions with people. These efforts are proven to be an awfully valuable defense against insurance fraud. Workers’ compensation surveillance has also been a sturdy tool in detecting fraudulent activity. Our investigator’s knowledge of the laws of surveillance techniques in pair with the use of the latest high-tech to induce evidence that’s irrefutable and admissible in court.
ACTIVITY CHECK
Our private investigators can monitor and make a record of the activities of someone who is attempting to create a claim for an injury or other loss. the aim of the activity check is to verify whether the statements of loss and facts submitted to the underwriter are factual. Activity checks are available in the shape of neighborhood canvasses, discreet pretexting, and/or interviews.
CIVIL/CRIMINAL BACKGROUND CHECKS
When a claimant is being investigated for fraud, gaining an understanding of their past history may be very helpful. the aim of a background check is to uncover any criminal convictions, civil court records, residence history, or other adverse information that would play part in determining the claimant’s character being investigated for fraud.
SOCIAL MEDIA/INTERNET CHECK
Our private investigators use social media research when investigating a case of insurance fraud. Plenty of helpful information may be learned about someone on today’s social media outlets, like Facebook, Instagram, Twitter, and others. An individual who is making a claim for an injury could post an image of themselves skiing, running in events, or playing sports. This type of data can play a critical role in proving that somebody is trying to commit fraud on an insurer.
ASSET CHECKS
Understanding a personality’s financial position is crucial in determining possible motives for committing fraud. If an individual is financially desperate or bankrupt, this might be a remarkable thing about trying to commit fraud with an insurer. Also, any statements to an insurance carrier about the financial position of a claimant will be verified similarly.
EMPLOYMENT CHECK
Our investigators check to confirm the claimant’s work history and employment status. This may help a fraud investigator further understand a claimant’s background who may be trying to file false claims. additionally, an employment verification with a brief period of surveillance may show evidence of a claimant working, when his submitted claim states that they’re unable to do so.
SKIP TRACE
This service includes the locating of a person’s whereabouts or residence. Sometimes an individual who is trying to commit fraud will vanish by moving to a different state or city. The skip tracer’s ability to locate someone is very beneficial during a claims investigation.
We at Lex Florida Investigations are committed to helping your company detect, investigate and stop fraud at all levels. Our seasoned private investigators will do everything through our professional network to see that fraudulent acts are stopped in their tracks. Let’s stop insurance fraud from costing your business money.