Insurance Investigations

Insurance investigations are usually conducted to investigate matters pertaining to insurance claims that are suspicious or otherwise in doubt for some reason. Investigators in this field have differing specialities and backgrounds. Some insurance companies have their own in-house investigation teams while other companies sub-contract the work to private investigators or private investigation firms. Although such investigations are usually conducted to combat fraud, very often investigators will be working simply to establish the circumstances of a particular claim (for example, in a multi-vehicular road accident involving various parties, claims and insurance companies).

Insurance Fraud

Methods of defrauding insurance companies are manifold, as are the means of investigating them. As a crime, however, evidence shows that insurance fraud in wealthy nations is increasing, with many governments running public awareness campaigns to deter potential fraudsters and appeal to the public to report any suspicious claims.

One of the most common forms of insurance fraud is the exaggeration of injuries sustained in an accident. For example, a claimant in a vehicle accident who sustained genuine injuries may exaggerate their extent, their effect on his ability to work or enjoy life and the length of time it takes for the injuries to heal. Such exaggerations are made with the intention of receiving a higher amount of money. Because many injuries can be exceptionally difficult to quantify (for example, psychological injuries or physical injuries such as whip-lash), investigators will often seek to establish that what the claimant claims is true (for example, if a claimant states he or she cannot work) and that there are no obvious discrepancies in the symptoms claimed (very often examined in conjunction with medical staff). Surveillance is often employed in such circumstances to verify the claim.

Another form of lesser known fraud is that of claiming on an insurance policy for injuries sustained before the policy came into effect. For example, in a road accident, a person may claim to have sustained a debilitating back injury. On investigation, however, it transpires that the injury had been sustained in an incident some months or even years before. Very often insurance companies and investigators will study medical reports and history to eliminate this possibility, as well as searching for evidence of previous claims or accidents.

There are also many forms of fraud involving property, some of which have garnered more attention in the media due to higher monetary value on the policies. An example would be a person with valuable assets (property, for example) who deliberately destroys them, often through arson, with the intention of then claiming the value back through insurance. Another form would be an art collector insurance a high value piece and then having it 'stolen' - claiming the money for himself and keeping the art piece in the process.