An insurance fraud investigation is an investigation which focuses on uncovering the facts regarding deceitful an fraudulent claims. When an individual commits insurance fraud, they are typically seeking compensation for either a false or fraudulent claim. In order to conduct an insurance fraud investigation, an investigator must be patient, intelligent, and have prior experience in the Special Investigative Unit (SIU).
Insurance fraud cases usually are a result of a person desiring the money from insurance services, which they can gain from making fraudulent claims about their health for medical insurance; falsifying claims via deliberate destruction of their car to gain auto insurance; and many other such fraudulent claims for the sake of gaining money via insurance fraud. The insurer and his financial health are hurt by insurance fraud.
Those aren’t the only kinds of insurance fraud out there though, as the insurer can also be the ones at fault. Whether it be in the medical field with an insurer not accepting a claimant and their request even though they have an injury; or perhaps in auto insurance where a claimant and their car or auto have been damaged, and the insurer refuses to give insurance; or even the insurer and their management having an unacceptable policy. And there’s many more insurance fraud cases that are a result of an insurer abusing their clients.
Of course, this is simply another form of theft, and thus is a crime throughout the States. And where there’s a crime, an investigation for said crime is bound to happen. And so we come to the question of which investigation services one should get. Most people would prefer an investigation service that would fit their financial constraints, or those whose management will get the case done to fit time constraints.
Well worry no longer, the right services are here for you in the form of Root Investigations. We’ll do an investigation for insurance fraud and dispute any fraudulent claims with the information and evidence that we’ll find. With the help of a trained insurance fraud investigator, our services will get the evidence and information back to you as soon as we can in order to prevent insurance fraud from occurring.
What Types Of Insurance Fraud Are Given An Investigation?
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 a fraudulent injury that they claim to 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 for auto insurance. Types of insurance fraud from this section include purposely colliding with another car, purposely damaging an auto, car theft insurance fraud, and trying to obtain car insurance 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 will be able to determine if the individual is either lying or purposely damaging their property for a payout, committing a case of insurance fraud.
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 will then gather evidence to determine if whether or not the person is committing this case of insurance 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 or if it is a case of insurance fraud, and to 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 of items, either in the workplace or at home. Our investigation will then attempt to return said items to the original owner whenever possible.
Typically, an insurance company hires a detective in order to err on the side of caution when paying a claim that might be a case of insurance fraud. 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.
Of course, an individual claimant might also hire a detective in order to gain information about a claim that still hasn’t been resolved by an insurer. This is a case of insurance fraud where insurers delay or outright deny a claim even though evidence for such a claim being valid is there. In these cases, we investigate the insurers and management to find evidence of insurance fraud being committed by them.