Private Investigation Leads to Discovery of Insurance Fraud

There has of course always been fraud but insurance fraud is more common than you might think, especially with car insurance. Many insurance companies hire private investigators to make sure that the case is actually an accident and not a deliberate fraud. You would like to think that there were no car insurance frauds out there but the fact is that there are plenty and getting to the bottom is very important to prevent increases in premiums for everyone else. If an insurance company receives a high number of fraud cases they can lose so much profit that they have no choice but to pass in on the consumers through higher rates.

In this particular case the names have been changed to protect the individuals involved and the insurance company itself.  X insurance company had a client call them and explain that they had been in an accident.  They said that they were injured and 3 other people in the car had been injured as well. One man was complaining of severe head and neck pain, the others had back pain, neck pain, etc.  The road was dark and apparently the car had slipped off the road going down an embankment. A few days later the insurance company heard from the lawyers of the three other people involved in the crash and of course the people wanted their lost time and pain and suffering paid for by the insurance company as well. Several months of back and forth between insurance companies and lawyers commenced with X insurance company having to pay all four occupants of the car.

When a person higher up in the X insurance chain heard about the story they remembered back to when they had dealt with an early case where several people had faked a crash just to get some extra insurance money. The circumstances were very similar.  That employee decided to hire a private investigator who launched an insurance investigation. The investigations went on for several months with everyone claiming that the crash had indeed been an accident and that no one planned it. The insurance company was intending to pay all of the victims until they saw the investigator’s findings.  At the last minute the driver was shown discrepancies in the 3 other passenger’s statements and admitted to causing the car crash intentionally. This also coincided with a witness who had heard the group of people discussing the wreck. The insurance investigator ended up proving that the case was indeed a fraud.

Unfortunately cases like the one above happen quite often and this is why there is a need for more insurance and corporate investigators. These situations can slip through the cracks if diligent examinations of each claim are not conducted.  Some insured individuals, especially in slow economies, will do just about anything to make sure that they can make some extra money at the expense of the insurance companies. Some people out there need or want money so bad that they will intentionally cause a wreck or cut someone off to get hit from behind so that they can claim their injuries. As an insurance adjuster, the need to make sure nothing seems out of place is paramount. You have access to police reports and the right to have an investigator take statements even when the insured is represented by a lawyer.  This should never be bypassed if you have any doubt.  Over 90% of the time, you are correct when there are red flags.  Before paying out any money, doing your due diligence can really pay off for you and your company. Remember that people can be dishonest so it is always a good practice to conduct a full investigation before a settlement is reached.