Insurance Investigations
Encyclopedia
Insurance investigations are usually conducted to investigate matters pertaining to insurance
claims that are suspicious or otherwise in doubt for some reason. Investigators in this field have differing specialities and backgrounds. Some insurance companies have their own in-house investigation teams while other companies sub-contract the work to private investigator
s or private investigation firms. Although such investigations are usually conducted to combat fraud, very often investigators will be working simply to establish the circumstances of a particular claim (for example, in a multi-vehicular road accident involving various parties, claims and insurance companies).
, however, evidence shows that insurance fraud
in wealthy nations is increasing, with many governments running public awareness campaigns to deter potential fraudsters and appeal to the public to report any suspicious claims.
One of the most common forms of insurance fraud is the exaggeration of injuries. Because many injuries can be exceptionally difficult to quantify (for example, psychological injuries or physical injuries such as whip-lash
), investigators will often seek to establish that what the claimant claims is true (for example, if a claimant states he or she cannot work) and that there are no obvious discrepancies in the symptoms claimed (very often examined in conjunction with medical staff). Surveillance is often employed in such circumstances to verify the claim.
Another form of lesser known fraud is that of claiming on an insurance policy for injuries sustained before the policy came into effect. For example, in a road accident, a person may claim to have sustained a debilitating back injury. On investigation, however, it transpires that the injury had been sustained in an incident some months or even years before. Very often insurance companies and investigators will study medical reports and history to eliminate this possibility, as well as searching for evidence of previous claims or accidents.
There are also many forms of fraud involving property, for example when a person with valuable assets (property, for example) deliberately destroys them, often through arson, with the intention of then claiming the value back through insurance. Another form would be an art collector insurance a high value piece and then having it 'stolen' - claiming the money for himself and keeping the art piece in the process.
Insurance
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...
claims that are suspicious or otherwise in doubt for some reason. Investigators in this field have differing specialities and backgrounds. Some insurance companies have their own in-house investigation teams while other companies sub-contract the work to private investigator
Private investigator
A private investigator , private detective or inquiry agent, is a person who can be hired by individuals or groups to undertake investigatory law services. Private detectives/investigators often work for attorneys in civil cases. Many work for insurance companies to investigate suspicious claims...
s or private investigation firms. Although such investigations are usually conducted to combat fraud, very often investigators will be working simply to establish the circumstances of a particular claim (for example, in a multi-vehicular road accident involving various parties, claims and insurance companies).
Insurance fraud
Methods of defrauding insurance companies are manifold, as are the means of investigating them. As a crimeCrime
Crime is the breach of rules or laws for which some governing authority can ultimately prescribe a conviction...
, however, evidence shows that insurance fraud
Insurance fraud
Insurance fraud is any act committed with the intent to fraudulently obtain payment from an insurer.Insurance fraud has existed ever since the beginning of insurance as a commercial enterprise. Fraudulent claims account for a significant portion of all claims received by insurers, and cost billions...
in wealthy nations is increasing, with many governments running public awareness campaigns to deter potential fraudsters and appeal to the public to report any suspicious claims.
One of the most common forms of insurance fraud is the exaggeration of injuries. Because many injuries can be exceptionally difficult to quantify (for example, psychological injuries or physical injuries such as whip-lash
Whiplash (medicine)
Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension. The term "whiplash" is a colloquialism...
), investigators will often seek to establish that what the claimant claims is true (for example, if a claimant states he or she cannot work) and that there are no obvious discrepancies in the symptoms claimed (very often examined in conjunction with medical staff). Surveillance is often employed in such circumstances to verify the claim.
Another form of lesser known fraud is that of claiming on an insurance policy for injuries sustained before the policy came into effect. For example, in a road accident, a person may claim to have sustained a debilitating back injury. On investigation, however, it transpires that the injury had been sustained in an incident some months or even years before. Very often insurance companies and investigators will study medical reports and history to eliminate this possibility, as well as searching for evidence of previous claims or accidents.
There are also many forms of fraud involving property, for example when a person with valuable assets (property, for example) deliberately destroys them, often through arson, with the intention of then claiming the value back through insurance. Another form would be an art collector insurance a high value piece and then having it 'stolen' - claiming the money for himself and keeping the art piece in the process.