Methods of defrauding insurance companies are diverse, as are the ways of investigating them. Recent trends show evidence that insurance fraud in wealthy nations is increasing, with many enforcement agencies running public awareness campaigns to deter potential frauds and appeal to the public to report any suspicious activity.
One of the most common forms of insurance fraud is the exaggeration of injuries resulting from an accident. Such exaggerations are made with the intention of receiving a higher award or settlement on a claim. Since many of these injuries can be difficult to quantify from a “loss perspective”, (psychological and soft tissue), investigators are retained to establish the validity of these conditions. Often surveillance is used to verify these claim.
Another lesser known fraud, are claims on an insurance policy for injuries sustained before the policy came into effect. For example, in a vehicle accident, a person may claim to have sustained a debilitating back injury. Upon closer investigation, details are uncovered that the injury had been sustained in an incident some months or even years before. Very often insurance companies and investigators will seek to find past medical reports to eliminate this possibility, as well as searching for proof of previous claims or accidents.
There are also many forms of fraud involving property, some of which receive more attention in the media due to higher monetary value of the policy or notarity of the person or property associated with that claim. An example would be a person with valuable assets (property, for example) who deliberately destroys it, often through arson, with the intention of cashing in on the value of their insurance policy. Another form of high value fraud would be an art collector who reports a piece of art or collection stolen – cashing in on the insurance claim and reselling the art piece on the black market.
Some Insurance Clients
ACE North American Claims
ACE Group is one of the world’s largest multiline property and casualty insurers. With operations in 54 countries, ACE provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients.
AXA Insurance Company
AXA’s primary life insurance company, AXA Equitable Life Insurance Company, is among the largest life insurance and retirement savings companies in the United States, with nearly 2.7 million customers nationwide. More than 5,100 AXA Advisors assist individuals, families and business owners in creating strategies that help them move forward on the road to financial security.
Chubb Insurance Company
Chubb Group provides a full range of insurance and risk management services for individuals, homes and businesses.
FOJP Services Corporation
FOJP is a leading risk management organization serving a group of hospitals, long-term care facilities and social service agencies in metropolitan New York City. Some of the city’s most important and highly regarded academic medical centers—and more than 10,000 physicians—participate in FOJP’s medical professional liability insurance program, the first of its kind in the nation.
Gallagher Bassett Services
A worldwide company offering claims management, information management, risk control consulting, and appraisal services.
Hartford Insurance Company
One of the largest insurance and investment companies based in the United States, with offices in Japan, United Kingdom, Canada, Brazil and Ireland.
IAT Specialty is a marketing, underwriting and claims office for a group of property and casualty insurance companies. IAT Specialty operates in Omaha, Nebraska and Scottsdale, Arizona.
Markel Southwest Underwriters
Based in Richmond, Virginia, Markel markets and underwrites specialty insurance products and programs to a variety of niche markets.
Medical Liability Mutual Insurance Company
MLMIC is not only the largest writer of medical professional liability insurance in the State of New York, but also one of the largest companies of its kind in the nation. Across New York State, MLMIC insures nearly 16,000 physicians, 4,000 dentists and dozens of hospitals.
New York Central Mutual Insurance Company
A family owned property and casualty insurance company employing over 1,000 dedicated insurance professionals, located in central New York.
Podiatry Insurance Company of America (PICA) is the nation’s leading provider of medical professional liability insurance for podiatric physicians in the United States. For over 30 years, we have provided medical malpractice coverage while supporting and enhancing the podiatric profession through sponsorships, risk management seminars and annual scholarships for podiatric medical students, to name a few.
Scottsdale Insurance Company
A wholly owned subsidiary of Nationwide®, Scottsdale Insurance Company benefits from the backing of one of the largest insurance and financial service providers in the United States.
The Travelers Companies, Inc.
A leading property casualty insurer selling primarily through independent agents and brokers
Tower Insurance Company
Tower Insurance delivers a broad range of property and casualty products to individuals and businesses throughout the US.
Utica First Insurance Company
Utica First Insurance serves the insurance needs of property owners in New York, New Jersey, and New England.
Zurich Insurance Company
Zurich is an insurance-based financial services provider with a global network that focuses its activities on its key markets in North America and Europe.