Image via Flickr user Still Frei

I almost got busted for insurance fraud once. That was when I microwaved oily bacon in tinfoil and set most of my kitchen on fire. “You were safe from fraud charges all the time Ryan.” I was? “Yeah, because stupidity is not the same as fraud.” LOL, damn right, the joke’s on them huh? Anyway, here’s how they investigate it:

What Exactly is Insurance Fraud?

In health insurance, there are broad kinds of insurance fraud. According to P., these are “fraudulent claims, and premium frauds.” Of the two, the latter is more common.

1. Checking the History of Claims

P. warns that insurers “talk to each other,” and are on guard when they realize someone has a history of repeated claims.

2. Checking the Timing of the Claim

Mugan says he’s often called in due to the timing of a claim. An example is when someone gets a medical condition just after buying a policy, or if all the old computers in an office are damaged shortly after general insurance is bought.

3. Actual Stakeouts

If you claim you can’t work, and your insurer finds it suspect, they might put you under surveillance.

If the investigator (very often a Private Investigator) spots you head banging in a nightclub despite your whiplash, the pictures will show up when you’re dragged to court.

4. Damage Analysis of Property

When property is damaged, investigators compare the type of damage to the claims being made. This is fairly easy in cars, thanks to dash cams.

5. Financial Background Checks

This is related to point 2. A suspicious insurer starts to check for debt, in particular decreasing credit scores. They might also note the sale of a house or car.

6. Stalking Social Media

These days, investigators have begun to monitor social media sites. These are a goldmine of information (not to mention photographs), and it’s easy to make a slip-up on Facebook.

Or congratulate him on his new job in the same line, even though he claimed he was unable to work in the same occupation.”

by Ryan Ong

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