Insurance Fraud Investigation

An insurance fraud investigation is a type of fraud investigation that centers around attempts to benefit from deceitful claims. Seeking compensation for false or inflated claims is illegal, dangerous, and raises the price of insurance for everyone.

Types of Insurance Fraud Investigation:

Health Insurance:

This investigation determines whether someone is getting paid for health care they are not receiving or is filing health care claims that are not valid or needed. Investigators will search billing records to make sure that doctors and patients are not colluding to commit fraud.

Car Insurance:

Some criminals stage accidents in which they purposely collide with another car, then accuse the other driver of fault in order to file claims. Others attempt vehicle theft fraud, trying to get money for a car that is not stolen.

Home Insurance:

With home insurance fraud, investigators discover disaster fraud, including false damage claims. They will often determine if the claimant upgraded their coverage right before the claim was filed. Investigators will also verify the validity of property damage claims.

Life Insurance:

This type of investigation uncovers cases of people who claim too much life insurance or claim it while still alive. Investigators also verify the existence of those claiming life insurance.

Insurance Company Fraud:

Bad practices can also occur within the insurance companies themselves. If an insurance company takes money but does not sufficiently compensate, an investigator can aid with resulting court cases. 

Workers Compensation Insurance:
When workers claim compensation for an injury, a workers compensation investigation will confirm the severity of the injury and whether the accident occurred while the person was working.

The Private investigator is a trained individual to handle such fraudulent workers compensation claims. He/she has required tools that help uncover the fraud and provide proof that is admissible in the court. The primary step in investigating the worker compensation claim is to detect any possibility of fraud. To uncover fraud in compensation claims it is necessary to act fast before the evidence is destroyed. Private investigators use several techniques to find out fraudulent worker compensation claims such as

1. Interviews and research

Private investigators generally interview employees who seek worker compensation claims. The interview questionnaire contains all types of questions that establish every detail of the claim. The answers are recorded which can be used as evidence in court. Private investigators collect all documents such as photographic evidence of incident and treatment copies that are helpful to detect fraud. A basic research in worker compensation claims can reveal lots of information that is generally not gained through casual observation. A private investigator knows the right places and ways to conduct research and collect information that can tell about any existence of fraud.

2. Background checks and research

Private investigators conduct background checks to investigate whether the worker was truly injured. Background research generally involves checking for any claims in the past and whether the worker was convicted in any fraudulent claims in the past.

3. Surveillance

Private investigators use different types of surveillance including audio and video to determine if the worker is really injured the way he/she has claimed in the worker compensation claim. In case of a fraudulent claim, a surveillance record can be provided as a proof that shows the worker has exaggerated the medical condition or injury to get added benefits through a worker compensation claim.

4. Evidence gathering

Evidence plays an important role in proving a fraudulent working compensation and denies compensation where the claim is not legitimate. A private investigator gathers a considerable amount of evidence that can be used to determine the right amount of compensation whatever is applicable as per the law.

Thus, hiring a private investigator is the best way to intelligently handle worker compensation claims and prevent fraud.

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