Investigating Insurance Fraud


Insurance fraud generally refers to instances in which a person tries to benefit from his or her insurance policy without being entitled to such benefits. This can occur when a person files a false insurance claim. Since the dawn of insurance fraud has been an issue, costing the industry billions of dollars a year. Insurance fraud is most common in life insurance, health insurance, and automobile insurance.

As per the definition of insurance fraud, it is the "intentional act of deceiving, concealing, or misrepresenting information that results in benefits being paid to an individual or group." When you insert information that is not accurate into your claim, it could be flagged as suspicious and determined fraudulent, even if it just has the wrong dates or you are filing a claim for much more than the value of the damages. Some even go as far as faking deaths or staging car accidents to make claims and collect damages. For all these reasons, insurance companies take serious precautions when evaluating each insurance claim that is filed.

How is Insurance Fraud Investigated?

Those who seek compensation for inflated claims collectively increase insurance rates for everyone. About $80 billion is paid out annually in fraudulent claims, leading to higher premiums and higher scrutiny for honest claims. Several methods are incorporated into a fraud investigation. These are used to determine whether claims are accurate or forged. Common techniques include:

  • Utilizing surveillance to verify the claim
  • Utilizing medical reports and reviewing medical histories
  • Researching previous claims and accidents
  • Analyzing insurance coverage
  • Reviewing witness testimony
  • Analyzing previous medical bills
  • Conducting a background check on the person filing the claim

Protecting your Insurance Claim

The best way to ensure that your claim is safe from scrutiny is to be completely honest about the information you provide and become completely familiar with your policy. Make sure that you file for damages that are covered. If you are unsure about how much to request, you should seek help from a personal injury attorney who has expert skills filing claims and negotiating with insurance companies.

While you do not want to sound the alarm, you deserve full compensation for your injuries, lost wages, and any property damage that may have been endured in the accident. If you are in the New Jersey area, the attorney you seek is James Vasquez of The Law Offices of James Vasquez, P.C. Call (862) 247-711 for a free legal consultation.