Common Elements Of Disability Insurance FraudAlmost everyone who is on disability insurance is justified in collecting benefits. Disability benefits are in place to help workers who find themselves unable to make a living because of an illness or injury. There are many different conditions that make a person eligible for disability benefits, and among those there are a few that are difficult to diagnose and treat. Criminals are taking note of this fact and are using these conditions to commit disability insurance fraud.
In all disability insurance claims, the claimant has the burden of proof on them to show that they are indeed unable to continue working as they have been. In the case of someone who is suffering from something serious such as a heart attack or cancer, they can expect to receive disability benefits for a period of several weeks, if not months. During this entire time they are required to consult regularly with a doctor who supplies authorized updates of the claimant's progress. The same is true of patients who suffer a serious injury, their doctor reports to the insurance company on their condition. In the case of fraud several different scenarios can take place. First, the doctor may be the one initiating the insurance fraud. This generally involves the doctor recruiting individuals who are eligible for disability benefits and then diagnosing them with conditions they don't really suffer from. The doctor continues to report on the patient's well being to the insurance company and the patient then pays part of the benefits back to the doctor. The more popular type of disability insurance scam involves claimants who feign an injury to collect their benefits. Obviously this can't take place if the claimant is pretending to have cancer or a heart condition, but in the case of injuries, it can be done. The patient typically visits their physician and complains of an ongoing painful problem. While the physician is in the process of diagnosis, the patient is told not to work. The doctor unwittingly fills out the required forms and the patient then begins to receive disability benefits. Every time an individual fills out an application for disability benefits they sign the document proclaiming that all the information is correct. This becomes vitally important if and when an insurance company realizes that they are a victim of fraudulent disability insurance claims. The individual then becomes liable for the benefits paid to date and also can be held criminally responsible. Almost every case of disability benefit fraud will eventually be found out because when a person remains on disability for a long enough period of time, the insurance company will request further medical documentation. This is typically in the form of a consultation with a physician the insurance company recommends. At this meeting, the ruse tends to be discovered. |