According to the FBI, non-health insurance fraud costs Americans a total of $40 billion each year, which results in about $400 and $700 increased premiums for an average family. Every one of us pays the price for insurance claim frauds committed by a few people, so it is important that companies investigate whether a claim is accurate and legitimate.
Let us look at the types of fraudulent insurance claims and how Evidence Investigators, Inc, can identify them.
Insurance companies often need to conduct investigations to determine if an insurance claim is valid or not and help them find out how to proceed with a claim.
Insurance claim frauds are rising in number every year and investigating them can help fight inflated or downright false claims. An illegitimate claim is untrue and cannot be justified, and by finding out about it early on, companies can save significant costs to them.
There are several types of insurance fraud that may need to be investigated:
False workers’ compensation insurance claims can be disastrous for a business’s finances. To ensure the claim is valid and should be paid out, an investigator will investigate the incident to determine these things:
For example, an employee who was injured after he had clocked outcomes in the next day to claim he was injured at work, is a fraudulent claim. However, a worker who had gone out of the workplace but was on a business-related mission in another place after-hours may have a legitimate claim.
A person may also file a false personal injury claim against another person or a business. The claim is illegitimate when a person was injured entirely due to his own negligence but blames it on a third party. For example, a person may have been injured while walking down their cracked driveway but staged the incident in front of a grocery store so that they could compensate him for the injury.
Depending on the property and the type of insurance claim (water damage, fire damage, break-ins, and burglary, etc.), an insurance company will need an insurance claims investigator who can come in and look for evidence.
The information gained through the investigation can help find out what exactly caused the incident and if it is eligible to be covered.
Healthcare claims, including those for Medicare and Medicaid, may be investigated by private investigators. Patients, as well as healthcare practitioners, can plot together to show inflated or fake injuries and illnesses, which require a larger compensation.
This is one of the most common types of insurance fraud and about 10 cents of every dollar goes towards paying for fraudulent healthcare claims.
An insurance claim investigation process consists of multiple steps, including:
Reviewing Documentation: Whether insurance companies must verify a health-related, property damage or an injury claim, they will need an investigator to collect the relevant documents from the relevant people. These documents will contain all the information about the day the accident was reported and are the key to corroborating details.
Witness Testimonies and Interviews: Investigators will also interview the witness and the perpetrator to find out what happened. Depending on the type of claims, the questions will differ. However, reviewing these statements later will help you form a clear picture of what really happened.
An investigator will also go to the place where the incident happened and take photos and videos of it. By assessing the physical environment, they may be able to make sense of what happened.
In addition, watching the suspect’s activity afterward may also show whether the claim was false. For example, if the person claims that they tripped on the cracked pavement outside a grocery store and hurt their ankle, keep an eye on the way they are walking and whether they are favoring the leg or if they can run and jump like normal.
Check Out Their Social Media: Checking out a person’s social media can also help investigators gain an insight into whether a person is lying or not. For example, if they made a post about meeting up with friends to go dancing, that can cast doubt on an injury claim.
Look for Previous Claims: Check out whether a person has made previous claims is also something investigators do. We can find out whether the person has a habit of making false claims or spinning the same type of stories before. This type of information can sway the outcome.
Many times, it is obvious that a false claim has been submitted. However, companies cannot refuse to pay out until they have concrete evidence. At Evidence Investigators, Inc, we can offer you the services of experienced private investigators in Boynton Beach, Palm Beach, Boca Raton, Broward County, and other cities of South Florida. We also have offices across the country and can work in any state. We can carry out investigations in a discrete way by employing a wide variety of covert and investigative skills.
If we find any information that a claim is not legitimate, we will back it with hard evidence so that you can deal with the matter in the appropriate way.
Schedule a consultation with us at +1 800-807-3160 or visit us at https://evidencepi.com/.