June 15, 2015

 Insureds and claimants are not the only ones to perpetrate fraud. Unfortunately, professionals will take advantage of insureds or the carrier for profit for themselves. The following checklist identifies some of the indicators that further investigation should be conducted. Three or more of these factors indicate that the claim should be referred to investigators for further research.

 ____Attorney reports claim to insurance company.

 

____Attorney is known as a lawyer who handles suspicious claims.

 

____Attorney's office is run by an administrator.

 

____Attorney is rarely or never seen at the office.

 

____Attorney lien or representation letter is dated the day incident was reported.

 

____High incidence of claims reported from attorney who recently passed the bar exam.

 

____Attorney and body shop frequently appear linked.

 

____All vehicles in reported loss are taken to the same body shop.

 

____Clinic may have continued billing or treatment irregularities.

 

____Clinic billing is done by an outside service.

 

____Clinic treats several or all of the claimants on same day.

 

____Physician immediately refers claimant for a wide variety of tests not related to original claim.

 

____Contractor has inadequate equipment to perform job.

 

____Contractor arrives at loss site without being solicited.

 

____Contractor offers cash incentives to get the job.

 

____Contractor is not bonded or insured.

 

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