Based on recent surveys, property fraud reached $34 billion per year between 2011 and 2015. Healthcare fraud alone reached $259 billion in the year of 2010.
Fraudulent insurance claims are reaching all time highs as people fake insurance claims. Fraudulent claims can range anywhere from forging dates on a claim form to faking an injury.
Thankfully, there are insurance investigators who look into these claims to ensure they’re legitimate. But how?
Read on to learn how an insurance investigator inspects insurance claims to fight fraud.
An insurance investigator will look at your past claims
An insurance investigator will go through your past claims to look for any red flags. They will take a look at how often you file claims and the nature of the claims.
Insurance investigators will also look for patterns to see whether or not specific people have more probability than others to commit fraud.
They use data analysis to track patterns for all of their customers. So any red flags will be picked up immediately.
They check off a list of suspicious loss signals
There is a list of suspicious loss indicators that was created by the The National Insurance Crime Bureau (NICB). In fact, in 2013 the NICB released a press release stating that they have noticed a 26% rise in questionable claims since 2010.
When insurance investigators look at claims, they take a look at this list to make sure there’s nothing questionable about the claim.
Some of these indicators include:
- Handwritten receipts when a repair has been done in damaged property
- An increase in home or auto insurance immediately prior to a submitted claim
- Significant financial debt on behalf of the claimant
- Lack of police reports after the supposed accident
While these indicators do not always prove fraud, they do force investigators to look deeper into the claim.
They look to computers for help
Thanks to technology, computer software exists to detect fraudulent billing and charges.
Investigators use this software to pull billing records for fraudulent activity. And it doesn’t matter the insurance type. The computers use data and trends to investigate the legitimacy of the claims. For claims such as health claims, these computer software programs look for multiple surgeries on one claim for the same body part.
But they can ultimately detect any fraud on any type of insurance, including auto insurance.
They’ll look at social media
Not all insurances will take a look at your social media pages. But if they suspect suspicious claims, they will take to social media for more information.
They will do a little digging to see if the claimant is in fact injured, or if their home is truly damaged. Social media often gives them the information they otherwise may not have found elsewhere.
As the statistics show, fraud is becoming prevalent across all insurance industries. From home to life insurance, investigators are taking a closer look at the claims that come through.
While most claims are legitimate, it’s always in their best interest to take a second look at suspicious claims.
If you’re in need of insurance investigators for your firm, contact us for more information.