Nowadays, insurance frauds are very common around the world. But, hiring an insurance fraud investigator can solve this problem. An insurance fraud investigator will go through how often you claim or the nature of your past insurance claims to look for any red flag or suspicious activity.

An insurance fraud investigator also investigates the claim patterns to find which person has more chances to commit fraud than others. They analyze all the data of their customers to track any red flag and avoid any loss.

Insurance Fraud Work and Commitments:

Insurance fraud is any act that people purposefully commit by deceiving an insurance company. The main reason for committing insurance fraud is greed. People explicit insurance agencies for getting financial benefits. Such kinds of frauds may be committed by applicants, policyholders, claimants, insurance agents, or even by their employees.

Private Investigators Work and Commitments:

A question might arise in your mind, that’s why an attorney would need to hire a private insurance fraud investigator. The answer is very simple; an attorney would need to utilize insurance fraud investigator services to prove an insurance fraud claim in court. Fake insurance claims or insurance fraud is a punishable crime. In case a person commits such fraudulent crime may experience hefty fines, probation time, prison, or even restitution.

How Insurance Fraud PIs Help Attorney’s to Solve Such Cases?

Private insurance fraud investigators are experienced in investigating and solving insurance fraud claim cases. They are properly trained and are skilled enough to offer complete and comprehensive investigations. They have special sources and tools that they use to collect and analyze customer data to uncover the fact.

Usually, like other white-collar crimes, insurance fraud cases are also subject to a lengthy investigation process. That’s why it is important to get help from an experienced and trained insurance fraud investigator if you suspect any such activity. An experienced investigator knows well how to solve and investigate such kinds of fraudulent cases.

How Insurance Fraud PIs Handle Fraud Cases?

Attorney’s hire private insurance fraud investigators to investigate and observe the suspected person. The first step to start the investigation is to locate the suspect. When the investigator finds the suspect, start the surveillance, according to the law once the investigator collects all necessary evidence and information to the attorney.

Usually, there are two kinds of general investigation cases, including auto and domestic cases. Insurance fraud investigators work with attorneys and insurance agencies to track and investigate the daily activities of a suspected person and report immediately to them. An experienced investigator can assist the attorney in confirming the evidence of insurance fraud.

How Can It Happen?

Some insurance companies avoid paying insurance claims. One of the ways that such insurance companies use to avoid paying insurance claims is to review the application of the policyholder. In case they find any suspicious activity or claim in the past, then the insurance agency can deny claim coverage, cancel the insurance policy, and pass the case to the federal government for further criminal prosecution.

The company has an insurance investigation staff that consists of private insurance investigators, prosecutors, and federal agents. Their main job is to check the background of the policyholder applicant for any suspicious activity or fraud, so the company denies covering the claim.

An insurance policyholder should treat an insurance fraud investigation the same way as federal prosecutors treat criminal investigations. Insurance agents and brokers also need the help of federal prosecutors and insurance regulators to avoid insurance frauds that include misuse of premium funds, unregulated selling, and marketing of insurance products.

Insurance Fraud: All Types of Insurance Fraud Claims

In this ever-growing world, no sector is free from fraud or fake cases, including insurance agency claims. Moreover, the insurance agencies, insurance policyholders, and the people who get insurance benefits may be under an insurance fraud investigation or can potentially commit insurance fraud to get insurance benefits or avoid paying claims.

To understand insurance fraud clearly, it is very important to know about the main types of insurance fraud.

  • Soft Insurance Fraud: This kind of insurance fraud happens when any policyholder who is eligible to place a claim inflates the actual insurance amount claim. For instance, a person who files a claim against rental insurance of a place, but inflates the claim amount to stolen property. In such cases, the claimant has a lawful claim; they just inflate the actual amount of the claim.
  • Hard Insurance Fraud: When an individual files a fake insurance claim, then there has been no loss or proper reason to file an insurance coverage claim. For instance, if you are faking someone’s death, robbery, or injury to get insurance benefits. In some cases, the paramedical staff is also involved who bill the insurance company for the services that were never provided to the patient.

The Cost of Insurance Fraud:

According to the statistics from the FBI (Federal Bureau of Investigation), a consumer spends an average amount of about $700 annually to cover fake insurance claims.

The investigation process of an insurance fraud case may be lengthy, but it is perused until charges of fake claims or insurance fraud are completely proved. The investigator continues the investigation and finds the evidence or information to prove the case in court.

Final Verdict:

You may have once been approached by an insurance fraud investigator inquiring about a worker’s compensation claim, healthcare claim, or rental insurance claim. Usually, it is not a red flag if you believe you haven’t done anything improper. But you may need to consult an experienced insurance investigator before answering all questions.

As soon as you contact an insurance attorney, they can find a way to figure out the problem and solve it. In some cases, an insurance attorney can help to stop the investigation and prove that you are innocent.

Frequently Asked Questions (FAQs):

What is the job of an insurance fraud investigator?

The basic responsibility of an insurance fraud investigator is to investigate and verify the validity of the claim that a policyholder files and, if it is true, how much amount the insurance company will pay for them.

What things does an insurance investigation consider in the investigation?

An insurance investigator looks and checks past claims of the insurance agency. They investigate the nature of the claims and how often a person files the insurance claims. Insurance investigators are also looking for past claim patterns to find the potential people that can commit fake claims.

What things should a person avoid saying in front of an insurance investigator?

A person never says sorry or admits any kind of fault in front of an insurance investigator. Keep in mind that the job of the claim adjuster is to reduce the claim liability of the insurance company, even by a small detail. Any act of admitting your fault can compromise the actual claim amount.

Do insurance agencies hire investigators?

Insurance agencies commonly hire private insurance investigators to perform surveillance of any claim. Their main job is to find and verify the authority of claims to reduce the liability of the insurance agency. So, it is important to consult an attorney before answering the questions of claim adjusters.