Different Insurance Fraud Detection TechniquesEliminating insurance fraud is likely never going to happen. Criminals are coming up with new techniques to cheat insurance companies out of money all the time. As one method of insurance fraud is detected, they graduate to more sophisticated ideas. Almost every insurance company has insurance fraud detection specialists who are trained to recognize any inconsistencies in the claims that are made.
Every insurance company has their own set of detection techniques but a common one is to flag clients who make large claims on a regular basis. How this works is very simple. Each time someone claims on their policy, a number is placed next to their name. As the claims increase, so does the number. At a certain point the insurance fraud detection specialists give more credence to the idea that fraud is taking place and they investigate the claim in detail. There are some red flags that immediately jump out to those who are trained to detect insurance fraud. One is a suspicious claim for an automobile accident. If they person who is reporting the accident has a wildly different story than the other person who was involved, this may suggest that fraud is taking place. One very common type of insurance fraud that focuses on automobiles is when an insurer is in a minor accident and then creates more damage so they can also claim for injuries. Gathering statements and locating witnesses are often the detection techniques used in this case. In terms of disability and health insurance the detection techniques are typically the same. If someone is suspected of cheating either their health insurance or workers compensation out of disability claim money, an investigation will be launched. One of the most effective methods to detect insurance fraud in these types of cases is by watching the insured. It may seem an expensive endeavor to have an investigator following a claimant, but if there is reason to believe they are able to do physical activities they claim they can't, the time spent is well worth it. In this type of case, the investigator will try and secure either photographic or video evidence of the individual performing tasks they claimed they couldn't. Arson investigators are often called to help detect insurance fraud as well. If someone is believed to be involved in burning down their own property in order to benefit financially, this will usually be thoroughly investigated on all angles. Not only will an arson investigator work to determine what caused the fire, but anyone close to the person suspected of insurance fraud will be questioned at length as well. Insurance companies obviously need to protect their interests and with the proper fraud detection techniques they can do just that. For each case they prove as fraud, they end up saving their company a lot of money. |