Insurance Fraud: the problems, the solutions, and the ways to avoid both

Unfortunately, insurance fraud is prevalent and incidents are increasing significantly. The reasons for this include:

1. Bad actors taking advantage of available pandemic-related, government, or other resources
2. Individuals with legitimate injuries who exaggerate their damages
3. A desire by insurance companies to save money using improper or inadequate investigative resources
4. Confusion or ignorance regarding the ramifications of untruthful reporting, insurance claims, or legal matters

All of these concerns can be addressed with different techniques such as surveillance investigation, due diligence investigations, background investigation, and social media research conducted by investigative agencies, in conjunction with insurance and legal professionals.

>Insurance Fraud and Surveillance

The most often considered investigative tactic to detect insurance fraud is surveillance. Surveillance is the locating, following, and reporting on an individual’s movements as they live their life. The legal limits to surveillance include restricting the monitoring to public places. That means that investigators are not permitted to go into a person’s private space (i.e. their homes or offices). Despite that limitation, the majority of what an investigator needs to disprove a person’s insurance claim is available when they do the most mundane activities: go to the supermarket, grab a cup of coffee, or drive to work. Due Diligence and the need for a closer look

Depending on the details of the claimant’s story, due diligence research may be needed. Here, the totality of the circumstances surrounding the alleged injury is reviewed under a microscope to find the slightest inconsistency. Once uncovered, the inconsistency is scrutinized even further and often uncovers the falsehood upon which their claim is based. Due diligence leads to the unraveling of a fraudulent claim. How a claimant’s past impacts their present claim

How can a person’s background information lead to information about their claim, including possible fraudulence? Patterns.

Much like artificial intelligence, a major facet of investigations is the prediction of human behavior based on expertise, which relies on the individual’s past and the investigator’s experience. If in the course of a background investigation it is uncovered that the claimant is overly litigious, a red flag is immediately raised. Either they are consistently unlucky, or they are consistently searching for a quick dollar. Further, if it is determined that the person is in financial straits, it is reasonable to infer that their claim may be more sinister than it initially appeared. Conversely, a background report may confirm that there are no extenuating circumstances surrounding the claim. Either way, it is a best practice to rule out all alternative reasons for a person’s claim.

Social Media InvestigationIn most cases, people tell on themselves. The modern desire for attention, oversharing, and validation leads to many aspects of a person’s life being more public than private. This shift in lifestyle can be both interesting as a voyeur and detrimental as a claimant. In sharing more of their personal life, a person brings moments that were once private into the public sphere. This makes those moments now able to be scrutinized over and over. It takes minimal time and effort to screen record a person’s social media content and finds an action that contradicts their insurance claim. With that proof, the foundation upon which the claim has been filed begins to deteriorate. Investigative partners can save time and moneyAn investigative agency can perform tasks beneficial to an insurance company. Further, the agency has the dedicated professionals, requisite expertise, and proprietary infrastructure to complete their investigation faster and more efficiently than laypeople. Valentis is an expert agency staffed by expert investigators. The value of Valentis’ service offerings costs significantly less than the value of fraudulent claims that succeed. If a recent claim gives you pause, for whatever reason, it is worth discussing with Valentis staff to determine if investigative solutions are necessary.