Nationwide Legal Investigations and Marc J. Tropeano PI are experts in Insurance Fraud Investigations.
What is Insurance Fraud? Insurance Fraud is when a person or people provide false information to an insurance company to gain something of value that he or she would not have received if the truth had been told‚ they’ve committed insurance fraud. Here are some examples of Insurance Fraud Investigations:
There are two ways that criminals perpetrate the stolen vehicle insurance fraud scam. When a car owner sells his car to a body shop to be disassembled for parts and then reports the vehicle as stolen. The second most common way criminals commit car fraud is to sell the car to an overseas buyer, make the transaction without any paperwork, and then ship the car internationally before reporting the vehicle stolen.
In some cases, the driver and victim are the only ones in on the scheme. In other cases, the driver, victim, insurance investigators, and even some of the bystanders that give statements are in on the fraud. The value of the vehicles is greatly inflated, and the insurance payoff is for two totaled vehicles at the end.
Some will report a small vehicle accident, get an estimate for damages, collect the insurance check, and then not get the vehicle fixed. This is the most common form of vehicle insurance fraud. The people doing it see no harm in it, but the money the insurance company pays outcomes from the premiums that are paid by other customers.
Health Insurance Billing Fraud
Health care professionals will, at times, get in on the insurance fraud act. One form is for health care providers to bill health insurance companies a higher than normal fee for a standard procedure, or to bill for services that were never received.
Staged Home Fires
One of the most common forms of homeowners insurance fraud investigations is the staged fire or act of vandalism. The homeowner either removes valuable family items before the fraud takes place, or the homeowner makes sure the insurance company knows the value of the expensive items and then has them destroyed.
There are people that will take advantage of any situation, including a major storm. A form of fraud that happens in the wake of major storms is homeowners will either enhance the storm damage to get more of a settlement, or the homeowner will take advantage of how busy the insurance company is and call in a claim even if there was no storm damage.
This form of insurance fraud is common. There are those that will take out a life insurance policy on themselves and place their spouse as the beneficiary. After several months, they fake their death, and the spouse is paid the death benefit.
Those who rent may take out a renter’s insurance policy to cover the cost of their possessions. Before moving or when financial times get bad, the insured will sell their possessions and then report them stolen to collect the insurance money.
Workers Compensation Fraud
There are many ways people commit workers’ compensation fraud:
The employee gets injured off the job but says they’re hurt at work, so their worker’s comp covers the medical bills. A worker has a minor injury on the job but insists their back is seriously hurt. By saying this, it allows the worker to collect more workers’ compensation money and allows them to stay off the job longer than they would if they did not inflate their injuries.
Some simply invent injuries because they are tough to disprove, and are easier to get away with. There are times when a worker may have an old injury that never healed and will claim they just got hurt on the job. When a worker stays at home longer after an injury and pretends to be disabled even though they’ve had enough time to heal is called Malingering.
Workers’ compensation insurance helps to protect those who are hurt on the job. This valued employee benefit pays for medical expenses, lost wages, and other expenses while a worker heals.
Most employers and employees are very honest. Only a small number scam this coverage for personal profit, but the damage they cause is enormous. Workers’ comp fraud is a large crime in America today. Tens of billions of dollars in false claims and unpaid premiums are stolen every year. Scams are forcing premiums higher draining business profits and costing honest workers their pay and jobs.