5 Things You Need to Know about Insurance Fraud Investigation

Insurance Fraud

Insurance fraud investigations are an important part of any insurance company’s risk management strategy. Fraudulent claims hurt both the finances of the insurance industry, as well as the general public by raising premiums. In extreme cases, insurance fraud can directly affect the lives of those involved through unnecessary (and dangerous) medical procedures, and staged (but still deadly) automobile crashes. Insurance fraud investigators can sort out truth from fiction, saving both unwitting consumers and the insurance industry millions of dollars.

Here's 5 things you need to know about insurance fraud investigation tactics, methods, and trends:

1. Insurance Fraud is Common

Fraud is more common than people think. This is in part because when people think of insurance fraud, they think of “hard” insurance fraud, which actually represents the minority of cases. Burning down a building or crashing a car on-purpose is what’s called hard insurance fraud because the source of the claim was entirely manufactured. On the other hand, soft insurance fraud is far more common because it consists of simply inflating the value of a legitimate claim. This type of fraud takes up the majority of an insurance fraud investigators’ time.

2. Data Analysis Can Flag Cases - but it Can't Prove Fraud

While statistical analysis and machine learning might be making the job of flagging potential fraudulent claims easier for medical, automotive, and general insurers, but the job of actually investigating insurance fraud still falls to specialized professionals like private investigators. When a potentially fraudulent claim comes across an insurance investigator’s desk they have a variety of tactics they can employ, from old school stakeouts to advanced web research to gather evidence to justify denying a claim, or even bringing legal action against a claimaint.

3. Surveillance are Still Important Ways of Catching People

Why is surveillance so important? Surveillance can make sure someone's claims are backed up by their behavior. If someone is claiming an injury, then their activities and lifestyle should be consistent with that. When it’s not, you most likely have a case of fraud - and surveillance can provide compelling evidence of that.

4. Social Media Can be Used to Catch Fraudsters More Often Than You Think

private investigators are skilled at tracking down all social media accounts associated with an individual, and collecting usable evidence from them. Even when someone is attempting to hide activities or evidence of fraud, slip ups can still be found with careful analysis. For instance, friends or family could post photos of them they aren’t aware of, or the location metadata from a photo might provide evidence of travel that’s inconsistent with their claim.

5. Background Research Can Point Investigators in the Right Direction

Information from background research may not provide absolute proof of fraud, but it almost always   gives grounds for placing a claim under even greater scrutiny. Armed with this data, an insurance investigator can act decisively to determine whether a claim has merit.

Investigative Resources of Texas

If you have time on your hands and need a few laughs, give us a call or meet us for a cup of coffee so we can share classic stories of insurance fraud in Dallas that we’ve handled over the past 20 years. We’ll tell you about the dude who claimed he couldn’t walk without a back brace after a bad fall, yet mixed, poured and smoothed the concrete for the foundation of his home.

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