Investigating Suspected Insurance Fraud in 2019

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Insurance fraud can take many forms. It can be as simple as bending the truth about how an accident occurred, or it can be a more complex fraudulent scheme. No matter how it happens, it is illegal. Insurance fraud costs insurers over $40 billion per year. Some of those costs pass down to policyholders. For the average U.S. family, insurance fraud costs between $400 and $700 in increased premiums every year. 

Types of Insurance Fraud

The insurance industry identifies two types of insurance fraud: hard and soft fraud. Hard fraud occurs when a person commits fraud by fabricating a claim. Soft fraud occurs when a person bends the truth or adds an element to their story to get more money. 

For example, suppose a person injured their back playing a sport over the weekend. Then, that person tells his or her boss that they suffered a back injury while at work. That person files a workers’ compensation claim to collect benefits. This is considered “hard fraud.”

Insurance Claims Investigations: Investigating Fraud

Insurance claims investigations are key to exposing fraudulent claims. Once insurers suspect fraud may be occurring, they hire insurance fraud investigators. These investigators work in a variety of ways to collect evidence. 

Evidence can give insurance companies the leverage needed to negotiate their claims. Evidence may include photos of the person “uninjured” on social media. It may also include reports that they called a car repair shop days before they filed a car accident claim.

Medical Background Investigation Services 

Our insurance claim investigation services can include investigating a person’s medical background and social media profiles. We provide a comprehensive analysis of the injured person. This includes social media and online searches, medical canvassing and records retrieval

A medical background investigation has many benefits:

  • Verifying important medical history
  • Verifying undisclosed information about the person
  • Verifying information about the injury

Investigating insurance fraud may involve canvassing multiple local healthcare facilities to determine if they received treatment elsewhere for an undisclosed injury. 

For example, a full medical background investigation may reveal that the injured person sought treatment for a back injury at a local hospital on Sunday. Yet on Monday, they filed a workers’ compensation claim. The investigation can help prevent workers’ compensation insurance fraud from occurring. 

Insurance companies want to pay legitimate insurance claims, and the goal with any type of insurance claims investigation is to uncover the truth to make better decisions about whether the claim is valid or insurance fraud. One of the best ways to achieve this goal is to work with an experienced medical background investigation team.

Contact Our Online Medical Background Investigators for Your Case

If you need help with a claims investigation, we can help. Contact the medical background investigators at Bosco Legal Services, Inc. We serve lawyers, insurance companies and business professionals nationwide.

Call our Riverside office today at (951) 289-5761 to discuss your situation. You can also fill out our online contact form and someone from our office will be in touch with you soon.