Fighting insurance fraud with private investigation

Insurance Fraud

There are many domains of application for private investigation. In each one of them, private investigators are hired to shed light on matters arousing suspicions from at least one party. This article is written from the perspective of insurance companies and explains how private investigation can be used to fight insurance fraud.

How Fraud Occurs

Because fraud is a rampant problem in our society, insurance firms need to protect themselves against policyholders who are always trying to gain access to the benefits to which they aren’t normally entitled. For instance, if a policyholder is covered for a list of accidents related to work but contracts an injury while at home, then they may try to file a fraudulent claim to avoid spending their own money. Another example is when an insured person exaggerates on an injury report to maximize their insurance benefits.

Deterring fraud

As you might know, insurance claims must be submitted along with several documents substantiating the financial request of the policyholder. For example, after a work-related injury the employee will undergo medical examinations and use the reports generated to submit a claim to their insurer. Once the claim has been submitted, the insurer will review it and assess its legitimacy. What may raise suspicions on the claim is the amount requested, especially if it seems to be disproportionate compared to the injury itself. This is usually going to trigger a private investigation, and ultimately the filing of a lawsuit by the insurer’s attorney.

Investigating the claim

The goal of the private investigation will be to gather evidence strengthening the suspicion that the claim is fraudulent. The private investigator will have at their disposal a number of tools to complete their mission such as placing the claimant under surveillance. For example, if the policyholder claimed that their injury prevents them from performing any kind of physical activity but is spotted lifting objects in their backyard, the investigator will know that the claim is a scheme.

Get legal assistance

Fraudulent claims are considered crimes nationwide. This means that there are specific legal sanctions for those who are found guilty of such schemes. Every time that a fraudulent claim is uncovered, the insurer needs to contact a lawyer who will make sure that the fraudster gets punished to the fullest extent of the law.

If you’re an insurer and believe that you’re being victim of fraud, please contact us today and we’ll help you prepare a solid fraud investigation case.