An insurance fraud investigation is an investigation which focuses on uncovering the facts regarding deceitful claims. When an individual commits insurance fraud, they are typically seeking compensation for either a false or inflated claim. In order to conduct an insurance fraud investigation, an investigator must be patient, intelligent, and have prior experience in Special Investigative Unit (SIU).
There are a multitude of types of insurance fraud which take place in New York State. The top types of insurance claims we typically see are:
Health Insurance and Perscription Cost Fraud: A health insurance fraud investigation entails hiring a private investigator to determine if an individual is obtaining funds for health care they are not receiving or obtaining funds for an injury they do not have.
Vehicle Damage and Insurance Fraud: This type of investigation determines if an individual is either staging a vehicle accident in order to file a claim. Types of fraud include purposely colliding with another vehicle, theft fraud, and trying to obtain money for a vehicle not stolen.
Home Owner Insurance Claims: Investigators focus on determining if the homeowner, who is claiming their house has been damaged in some way, is telling the truth. This can range from floods to arson to theft in the home. An investigator is able to determine if the individual is either lying or purposely damaging their property for a payout.
Life Insurance: A life insurance claim is when an individual takes out an exuberant amount of money on either themselves or an individual still alive, in hopes to gain a payout. Investigators determine if the person is committing fraud.
Personal Injury and Workers Comp Fraud: Many times, an individual becomes hurt on the job and receives workers comp or attempts to sue a company for their injury. Root Investigations conducts surveillance in order to determine if the individual is actually hurt and determine one’s activities while injured.
Internal Fraud: In addition to the above, sometimes insurance fraud is being conducted by employees at an insurance company. Our investigators specialize in determining if any individuals on the job are committing insurance fraud.
Theft and Burglary: This involves our private investigators analyzing any theft or burglary, either in the workplace or at home
Typically, an insurance company hires a detective in order to err on the side of caution when paying a claim. When hiring a private investigator, there are several methods a detective is able to use to determine if an individual is committing insurance fraud. Common techniques include surveillance investigations, medical reports, analyzing prior claims and accidents, insurance coverage analysis, witness testimonies, conducting a background check, and analyzing a physician’s billing information.