Fraud and the people who perpetrate it come in all shapes and sizes. From worker's compensation claims that involve several thousand dollars, to large commercial claims involving millions, all of the fraudsters share one trait – they thought they could get away with it.
The most frequent fraud cases involve worker's compensation claims, health insurance, auto accidents or personal property claims. As the amount of fraud increases, so do the tactics used by insurance investigators to catch the perpetrators. Insurance adjusters and agents can watch for red flags that may indicate fraud or at least the need to investigate a claim more closely:
- Look at the claimant's claims history – Has he filed similar claims recently or repeatedly? Are there any recurring or unusual patterns involved?
- Look for "Suspicious Loss Indicators" – The National Insurance Crime Bureau has a list of suspicious loss indicators that can tip off an adjuster or agent such as hand-written receipts or a claimant who's too calm after filing a claim.
- Look at the claimant's credit history – Is she in debt? Does he live above his means? Are there major medical bills or recent unemployment?
- Check out the claimants on social media – If there are pictures of him surfing, his back may not be that badly injured. Did what she said about the car accident on Twitter match her description of the accident? Or did someone upload a video to YouTube that shows what really happened?
Here are some not so creative fraudsters who were caught red-handed. Some of the cases are still working their way through the justice system, while others have been closed and the perpetrators sentenced.
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