Insurance agencies devote a lot of time and resources to detecting fraudulent claims. That’s because insurance fraud has always been a problem, and rates are on the rise. Even if fraud investigation isn’t your primary duty as an insurance claims adjuster, you’ll still need to know which red flags to watch out for when interviewing claimants and making your report. As someone who’s been in the insurance industry since 2008, I’ve developed a good sense of who is telling the truth and who is trying to be shady. Now I’m here to help you sharpen your lie-detection skills as well.
Some people commit insurance fraud because they think it’s a victimless crime and an easy way to make money. Nothing could be further from the truth. According to the FBI, insurance fraud is a $40 billion industry that costs American families between $400 and $700 a year in higher insurance premiums. There are many ways claimants try to defraud insurance companies. Here are some of the warning signs of insurance fraud you might encounter on the job.
Insurance Fraud Red Flags:
This red flag is a movie cliché for a reason. A person takes out an insurance policy on someone or something, and then that someone or something dies or gets destroyed. As the beneficiary of the insurance policy, the person stands to profit from this misfortune. It’s not always as dramatic as the movies make it out to be, but you should be aware of cases where the timing is just a little too good to be coincidental.
Long Claims History
If a person has a long history of filing insurance claims at the drop of a hat, they could be an unlucky individual, or they could be trying to game the system. This type of fraud is commonly attempted by reporting a car stolen or reporting valuable items missing after a break-in. Anyone who has ever submitted a claim has a file where their habits of reporting losses are analyzed. Any claims that don’t match the established pattern could be investigated further.
Claimants aren’t the only ones out to take money from insurance companies. Chiropractors, roofers, personal injury lawyers, and even doctors sometimes base their business on padding estimates and billing for services that were never rendered. You’ll quickly get to know the personal injury mills and shady operators in your area. If a claimant has partnered up with one of these types, it’s not a good sign.
Social Media Tip-Offs
There’s no shame in stalking a claimant’s social media to see if they’ve been talking about their loss or injury. Obviously, there are many people who don’t share their private business on social media, but it’s a pretty compelling case for fraud if someone is claiming to have physical injuries, but livestreams themselves surfing at the beach. Look for behaviors and photos that don’t match the person’s purported circumstances.
Something’s Just Off
Remember that sixth sense I said you’d develop when it comes to dishonesty? Some cases just set that off. Maybe the claimant seems more excited to get a check than concerned about the serious property damage or injury they’ve experienced. Maybe their receipts are all hand-written. Once you’ve worked enough cases, you’ll get a sense of what’s normal and what’s not, and you’ll learn when to trust your gut.
Learn All You Need to Know with 2021 Training
When you choose 2021 Training, you get the benefit of my years of experience in the insurance industry as I share real-world advice to help you during deployments and with your day-to-day work. Get personal access to me and your other instructors whenever you have questions about the curriculum. We’re here to help you succeed in your career as a licensed insurance adjuster. Check out our program today!