Insurance fraud can take
many forms. It can be as simple as bending the truth about how an accident
occurred, or it can be a more complex fraudulent scheme. No matter how it
happens, it is illegal. Insurance fraud costs insurers over $40 billion per year. Some of those costs
pass down to policyholders. For the average U.S. family, insurance fraud costs
between $400 and $700 in increased premiums every year.
Types of Insurance Fraud
The insurance industry
identifies two types of insurance fraud: hard and soft fraud. Hard fraud occurs
when a person commits fraud by fabricating a claim. Soft fraud occurs when a
person bends the truth or adds an element to their story to get more money.
For example, suppose a
person injured their back playing a sport over the weekend. Then, that person
tells his or her boss that they suffered a back injury while at work. That
person files a workers’ compensation claim to collect benefits. This is considered
Insurance Claims Investigations: Investigating Fraud
investigations are key to exposing fraudulent claims. Once insurers suspect fraud may be occurring,
they hire insurance fraud investigators. These investigators work in a variety
of ways to collect evidence.
Evidence can give
insurance companies the leverage needed to negotiate their claims. Evidence may
include photos of the person “uninjured” on social media. It may also include
reports that they called a car repair shop days before they filed a car
Medical Background Investigation Services
Our insurance claim
investigation services can include investigating a person’s medical background
and social media profiles. We
provide a comprehensive analysis of the injured person. This includes social
media and online searches, medical canvassing and records retrieval.
- Verifying important medical history
- Verifying undisclosed information about the person
- Verifying information about the injury
fraud may involve canvassing multiple local healthcare facilities to determine
if they received treatment elsewhere for an undisclosed injury.
For example, a full
medical background investigation may reveal that the injured person sought
treatment for a back injury at a local hospital on Sunday. Yet on Monday, they
filed a workers’ compensation claim. The investigation can help prevent workers’
compensation insurance fraud from occurring.
Insurance companies want to pay legitimate insurance claims, and the goal with any type of insurance claims investigation is to uncover the truth to make better decisions about whether the claim is valid or insurance fraud. One of the best ways to achieve this goal is to work with an experienced medical background investigation team.
Contact Our Online Medical Background Investigators for Your
If you need help with a
claims investigation, we can help. Contact the medical background investigators
at Bosco Legal Services, Inc. We serve lawyers, insurance companies and
business professionals nationwide.