Insurance Fraud Investigations

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Insurance Fraud Investigations

Insurance fraud is a deliberate deception perpetrated against or by an insurance company or agent for the purpose of financial gain. Fraud may be committed at different points in the transaction by applicants, policyholders, third-party claimants, or professionals who provide services to claimants. Insurance agents and company employees may also commit insurance fraud. Common frauds include “padding,” or inflating claims; misrepresenting facts on an insurance application; submitting claims for injuries or damage that never occurred; and staging accidents.

Statistics

  • Fraudulent claims total at least $80 billion per year in the United States.
  • Property-casualty fraud steals more than $30 billion each year.
  • Insurers pay out up to 10% of their claims cost on fraudulent claims annually.
  • At least 1 in 10 small business owners worry that their employees will fake work-related injuries.
  • The total cost of insurance fraud (non-health insurance) is estimated to be more than $40 billion per year.
  • Insurance Fraud costs the average U.S. family between $400 and $700 per year in the form of increased premiums.
  • All of this happens even though 95% of insurance companies use anti-fraud technology.

Workers Compensation Investigations

The Coalition Against Insurance Fraud (CAIF) estimates that workers’ compensation insurance fraud alone costs insurers and employers $6 billion a year.

Claimant Fraud

Examples of claimant fraud include over-utilizing medical care to keep receiving lost income (indemnity) benefits, exaggeration of symptoms, working while allegedly disabled and not reporting income, claiming a job-related injury that never occurred or claiming a non-work-related injury as a work-related injury.

Premium Fraud

Employers who misrepresent their payroll or the type of work carried out by their workers to pay lower premiums are committing workers compensation fraud. Some employers also apply for coverage under different names to foil attempts to recover monies owed on previous policies or to avoid detection of their poor claim record.

General / Auto Liability Investigations

Auto insurance fraud ranges from misrepresenting facts on insurance applications and inflating insurance claims to staging accidents and submitting claim forms for injuries or damage that never occurred, to false reports of stolen vehicles.

  • Personal-lines auto insurers lose at least $29 billion a year in premium leakage. This involves missing or wrong information that drivers provide insurers, which inaccurately lowers auto premiums.
  • Fraudulent claims mostly involved chiropractic treatments, physical therapy as well as alternative medical care. In other words, auto injury claim fraud and abuse accounted for between 13% and 17% of total payments for auto injury coverages.
  • No-fault scams cost the average two-car family in Florida $100 in increased auto premiums.
  • 21% of bodily injury claims and 18% of personal 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 thanks to no-fault scams.
  • No-fault fraud and abuse cost consumers and insurers about $658 million in 2011 in Florida alone.

Insurance Fraud Investigation and how we can help

Brener Insurance Fraud Investigators provides special investigations and surveillance services for insurance companies and private businesses in the United States. Our experienced investigators are can assist in the following areas:

  • SURVEILLANCE

    Private investigators utilize surveillance in the attempt to validate whether a claimant’s stated physical condition is true and verifiable, an investigator will monitor a subject’s daily activities, movements and interactions with other people. These efforts have been proven to be a very valuable defense against insurance fraud. Workers’ compensation surveillance has also been a powerful tool in detecting fraudulent activity. Our team of investigators are properly licensed, insured and have a full working knowledge of the laws pertaining to surveillance techniques. We use the latest high tech to obtain evidence that is irrefutable and admisable in court.

  • ACTIVITY CHECK

    Our private investigators can monitor and make a record of the activities of a person who is attempting to make a claim for an injury or other kind of loss. The purpose of the activity check is to verify whether the statements of loss and facts submitted to the insurance company are factual. Activity checks come in the form of neighborhood canvasses, discreet pretexting and/or interviewing.

  • CIVIL/CRIMINAL BACKGROUND CHECKS

    When a claimant is being investigated for fraud, gaining an understanding of their past history can be very helpful. The purpose of a background check is to uncover any criminal convictions, civil court records, residence history or any other adverse information that could play a part in determining the character of the claimant being investigated for fraud.

  • SOCIAL MEDIA/INTERNET CHECK

    In todays day, our private investigators know the importance of incorporating social media research when investigating a case for insurance fraud. A lot of helpful information can be learned about someone on today’s social media outlets, such as Facebook, Instagram, Twitter and others. A person who is making a claim for an injury could post a picture of themselves skiing, running in events, playing sports. This kind of information can play a critical role in proving that someone is trying to commit fraud on an insurance company.

  • ASSET CHECKS

    Understanding an individuals financial position is crucial in determining possible motives for committing fraud. If a person is financially desperate or bankrupt, this could be a motivating factor in trying to commit fraud with an insurance company. Also, any statements to an insurance carrier about the financial position of a claimant can be verified as well.

  • EMPLOYMENT CHECK

    Our investigators verify a claimant’s employment status and work history. This can help a fraud investigator further understand the background of a claimant who might be trying to file false claims. In addition, an employment verification with a short period of surveillance may show evidence of a claimant working, when his submitted claim states that they are unable to work.

  • SKIPTRACE

    This service involves the locating of a person’s residence or whereabouts. Sometimes a person who is trying to commit fraud will vanish by moving to another state or city. The skip tracer’s ability to locate a person can be very beneficial during a claims investigation.

    We at Brener Investigations Group are committed to helping your company detect, investigate and stop fraud at all levels. Our experienced investigators want to do everything possible through our professional network to see that dishonest people are stopped in their tracks. Insurance companies and private businesses have counted on Brener Investigations Group for years to provide them with a quality service. Contact us today to learn more about how our team can help you stop insurance fraud from costing your business money.