The purpose of insurance is to make regular payments in exchange for the peace of mind that you will be protected in the event of a catastrophe or accident of some sort. There are many different types of insurance that cover our lives in and outside of work, such as auto insurance, health insurance, home insurance, worker’s compensation insurance, and more. Should you encounter any of the situations covered by your insurance, you can then submit the corresponding claim and receive any benefits that apply. Unfortunately, in some cases, individuals see insurance as a way of getting access to another source of income with minimal effort and submit false claims to insurance companies, which is insurance fraud.
Depending on the tenacity of those involved and the amount of fabricated evidence presented, insurance fraud can sometimes be difficult to prove. At Amatrix Investigations, we work hard to ensure that insurance companies are protected from such false claims, allowing them to continue paying out benefits to clients that are truly experiencing hardships.
What Is Insurance Fraud?
There are many forms and instances of insurance fraud. However, generally speaking, insurance fraud refers to instances where someone has filed an insurance claim that is ultimately unsubstantiated, whether that means there was never any real evidence for the claim or that evidence has been falsified. Insurance fraud is often committed by individuals under the mistaken assumption that this will prove to be a simple method to get large sums of money in a short amount of time. Although, in some cases, insurance companies will be targeted by a group of organized criminals who have access to more resources than the average person, making the case far more challenging. Experienced private investigators are especially useful in more complex situations such as this one.
Other times, the perpetrators of insurance fraud aren’t directly involved in the insurance claim at all. Technicians and professionals providing a service to insurance companies, such as the auto repair workers responsible for restoring a motor vehicle to working condition in the aftermath of a collision, are also paid by insurance companies during the resolution of a claim. An attempt to inflate the cost of those services is also considered insurance fraud. Technicians might also attempt to increase their pay by including charges for services that were never performed, effectively padding the bill in their favor. If these additional costs and charges are relatively minor, this can be difficult to identify.
Insurance fraud is a fairly widespread problem, often made worse by an inherent misunderstanding of how insurance works. Individuals who have paid into their insurance for years without needing to file a claim may feel like they are losing money in the process. The most common targets of false claims within the insurance industry are health insurance providers, worker’s compensation, and auto insurance.
Insurance Fraud Committed In & Out of the Workplace
Despite the various categories of insurance, they can generally be divided into two categories, work-related insurance and personal insurance. A primary form of work insurance is worker’s compensation insurance, more colloquially known as worker’s comp. Depending on the number of hours you work, you may also be entitled to health insurance through your employer. Personal insurance would refer to the various other forms of insurance you hold outside of work. The main difference between the two is that the former is covered by your employer, while the latter is paid for directly by the individuals with no other third party involved. Because of the added involvement of an employer, work-related insurance fraud cases can present additional challenges.
Employees who are dissatisfied with their position or the company they work for might see insurance fraud as a viable way to secure additional benefits for themselves while hurting their employers. A common method of insurance fraud in the workplace is for an employee to feign an injury they claim was sustained during work. Another method involves claiming that an accident that occurred elsewhere, resulting in real injuries, actually took place on the premises. The latter can be harder to disprove because the individual’s medical records will confirm the injuries themselves are genuine.
There are plenty of insurance fraud incidents outside the workplace as well, and not all cases are premeditated. For example, in the event of a car accident, an individual might claim that dents and scratches already on the vehicle were actually caused by the accident or make similar claims regarding damage to their house after a natural disaster. These opportunistic claims are born out of a desire to increase personal benefits with little regard for how that might affect others genuinely facing expensive repairs.
What Can an Amatrix Private Investigator Do For You?
Whether you are an insurance company seeking to protect your ability to continue serving your clients by identifying and rejecting false claims, an employer whose entire reputation may be at stake, or a law firm working to uncover the truth, call us. Amatrix Investigations can help. Working with a private investigator allows you to benefit from their skills and experience as they uncover crucial pieces of evidence for your case.
Investigators can examine every aspect of the claim, including the details of the incident, the damages and injuries reported, and the costs of any services rendered. Their role is to take all the questions surrounding a case and provide much-needed answers. Is the employee really injured? Who was really responsible for the car accident? Were those leaks in the roof present before the storm? For example, in the event of a house fire, a private investigator will determine how the fire was started, helping clarify whether the fire was a legitimate accident or the result of fraudulent arson.
At Amatrix Investigations, our team is dedicated to finding out the truth. We have decades of expertise handling a variety of sensitive situations and will show the utmost discretion while working to protect our clients. Our investigators have experience working in law enforcement and are up to date on all current legal practices, ensuring that any evidence obtained will be admissible and relevant to your case. For a free consultation, simply fill out our online form or contact us by calling (213) 342-1767.