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Home > Services > Insurance Claims Investigations


Insurance Claims Investigations

Insurance Claims Investigations: Corporate, Internal / External Investigation, Litigation Support, Insurance Claims, Fraud, Theft, Wrongful Death, Accidents


Summit Loss Prevention Consulting personnel have been helping insurance companies uncover insurance fraud for more than 25 years. Among the many cost-efficient services we provide insurance companies of all sizes, our assistance can include locating witnesses or taking recorded statements.

We also offer post-incident photography services at the scene of an accident or a crime scene. Our highly-experienced investigators know what to look for and the resulting photographs can reveal critical data and clues that were overlooked in the immediate and chaotic aftermath of a traumatic event.

To ensure all pertinent physical evidence is known and considered, we highly recommend that all insurance adjusters use post-incident photography during their investigations.

Insurance Fraud Hurts Everyone!

The insurance companies must raise premiums in order to maintain their bottom line. The smaller companies and self-insured's are paying increased premiums and the consumer is hit hard with higher costs.

Our highly trained, skilled investigators can uncover the truth behind fraudulent insurance claims, including fire and theft losses and exaggerated injuries, to determine what truly happened or whether the incidents actually occurred or not.

Insurance Fraud: Providing Services Needed to Prevent It

These fraudulent claims include fire and theft losses, and exaggerated injuries, whether they occurred or not. Fraudulent claims arise out of automobile, product liability, general liability and workers' compensation accidents.

Summit personnel have served the insurance industry and claim’s managers in hundreds of investigated property loss claims cases with excellent results.

Examples of the types of cases Summit has worked on to assist the Insurance industry include:

  • Investigations into wrongful death claims
  • Accidents resulting in injury
  • Fraudulent Worker’s Compensation claims
  • Theft losses
  • Product liability claims
  • Criminal sabotage
  • Vandalism

Insurance Claim Fraud Investigations: Outsourced Investigative Services for
the Insurance Industry

Many insurance companies outsource significant portions of their claims investigations, and Summit has served this market well for many years. Working in close cooperation with insurance industry officials, case managers and claims adjusters, Summit has proven to be a valuable and competent partner in holding the line against fraud and other insurance abuses.

For examples of successful Insurance fraud investigations conducted by Summit, read Case Studies - Insurance Fraud.

Insurance Fraud Investigations: More Than Just Asking Questions

The Summit Loss Prevention Consulting team provides their professional skills in the following areas of investigation that have become necessary for our clientele to combat insurance fraud:
  • Accident Reconstruction
  • Scene Investigation
  • Video & Still Photography
  • Neighborhood Canvassing
  • Gathering and interpreting evidence
  • Statement Taking
  • Locating witnesses for trial
  • Review and secure court records
  • Service of subpoenas and legal documents
  • Background checks of expert witnesses

Insurance Fraud: Premeditated or a Crime of Opportunity?

There is no doubt that fraud causes increasingly higher insurance premiums for companies, businesses, and individuals to pay. The dictionary defines fraud as the intentional perversion of truth to induce another to part with something of value or to surrender a legal right.

Insurance fraud falls into 2 basic categories: “hard” and “soft (opportunistic).”

  • Hard fraud occurs when someone deliberately fabricates claims or fakes an accident. Criminals are using increasingly sophisticated electronic schemes to defraud insurance companies.
  • Soft insurance fraud, also known as opportunistic fraud, occurs when normally honest people pad legitimate claims or intentionally understate the number of miles they drive each year or, in the case of business owners, list fewer employees or misrepresent the work they do to get a lower premium.

Insurance Fraud Costs Everyone (A Lot!)

Insurance fraud costs American households and businesses more than $130 billion a year. That money comes out of the pockets of every individual and business that pays for insurance coverage of any type. It is estimated that insurance fraud costs the average American household more than $5,000 a year in the form of higher premiums and higher prices for goods and services. Some of the specific findings include:

  • Property/casualty insurance fraud cost insurers about $30 billion in 2004, according to the Insurance Information Institute
  • At the end of 2004, the Coalition Against Insurance Fraud said that auto insurance fraud amounts to $14 billion in false claims a year
  • Fraudulent Workers' Compensation claims total more than $5 billion a year, according to the National Insurance Crime Bureau 
  • The cost of health care fraud was estimated to total $85 billion in 2003 by the Blue Cross and Blue Shield Association and the U.S. Government Accountability Office, or 5 percent of U.S. health care spending. For Medicare, $1 out of every $7 was lost on fraud and abuse

Fraud may be committed at different points in the insurance transaction by different parties: applicants for insurance, policyholders, third-party claimants and professionals who provide services to claimants. Common frauds include:

  • "Padding," or inflating actual claims
  • Misrepresenting facts on an insurance application
  • Submitting claims for injuries or damage that never occurred
  • "Staging" accidents

Moral vs. Morale Hazards

To some extent, the existence of insurance coverage encourages losses. Even though insurers have an economic incentive to encourage loss control, insurance sometimes provides an economic incentive for insured's to have losses.

There are two general categories of hazards that insurance companies must deal with when it comes to fraudulent claims, Moral and Morale.

Moral Hazard

A Moral Hazard is a condition that exists when a person may intentionally try to cause a loss or may exaggerate a loss that has occurred. Nobody knows for sure how many car or building fires are started intentionally by people who would rather have the insurance money than the car or building.

More common are exaggerated or inflated claims. An insured may claim that four items were lost rather than the actual three, or that items were worth more than their actual value.

In liability situations, third-party claimants often exaggerate their personal injuries and property damage, and sympathetic physicians, lawyers, auto body shops, and contractors may support these exaggerations and drive up the cost of claims.

Morale Hazard

A Morale Hazard is a condition that exists when a person is less careful because of the existence of insurance. Morale hazard does not involved an intent to cause or exaggerate a loss. Instead, the insured becomes careless about potential losses because insurance is available. Leaving the keys in an unlocked car or allowing fire hazards to remain uncorrected are examples of morale hazard.

Moral hazard claims result in additional losses that drive up the costs of insurance because of injuries and damage that could have been prevented.

Indicators of Insurance Fraud

For information about the subject, and how to recognize potentially fraudulent insurance claims, read Insurance Fraud.

 

For information about conducting a comprehensive insurance fraud investigation, call 317-363-8312, send email to info@SummitLossPrevention.com. or submit the short form below:

   
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Summit Loss Prevention  •  1427 West 86th Street, #404  •  Indianapolis, IN 46260  •  317-363-8312  •  info@summitlossprevention.com

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The local and Midwest markets we serve in and around Indiana include Batesville, Bloomfield, Bloomington, Boonville, Brownsburg, Carmel, Chicago, Cincinnati, Columbus, Derby, Detroit, Edinburgh, Elkhart, Fishers, Fort Wayne, Fortville, Gary, Greenfield, Greensburg, Indianapolis, Kokomo, Lafayette, Lebanon, Louisville, Marion, Mooresville, Muncie, Noblesville, Notre Dame, Peru, Plainfield, Richmond, Rockport, Rockville, Rushville, Smithville, South Bend, Syracuse, Terre Haute, Topeka, Union City, Valparaiso, Wabash, Warsaw, West Lafayette, Westfield and Zionsville.