How do insurance companies investigate fraud?

Insurance claims investigations rely on evidence, interviews and records to conclude whether a claim is legitimate or illegitimate. Fraudulent claims raise the price of insurance for everyone, so it’s in a company’s best interest to verify that every claim is legitimate and accurate.

Do insurance companies have investigators?

While it’s true that insurance companies sometimes hire private investigators to gather information on people filing personal injury claims, it doesn’t mean they’re going to invade your privacy or hurt your case.

What is special investigative unit in insurance?

Special Investigative Unit (SIU) — unit or department within an insurance company involved in detecting and pursuing action against fraudulent activities on the part of insureds or claimants.

Why do insurance companies use investigators?

The investigator may be an auditor or legal professional working on behalf of the insurer. An investigator collects details about the incident/accident related to a claim by interviewing the claimant and witnesses. They will also start gathering physical evidence from the accident scene.

Is insurance a criminal fraud?

Insurance fraud is a “specific” intent crime. This means the prosecutor must prove that the person involved knowingly committed an act to defraud. An act is completed. Simply making a misrepresentation (written or oral) to an insurer with knowledge that is untrue is sufficient.

Is insurance fraud a felony?

Fraud is defined as a felony crime. Convictions would result in fines, imprisonment, a requirement to pay restitution, and disqualification from engaging in the business of insurance.

Do insurance companies send private investigators?

Why Do Insurance Companies Hire Private Investigators? Insurance companies often say they hire private investigators to help prevent fraud that would lead to an increase in premiums for their customers. Insurance companies often say if accident victims suffered a legitimate injury there would be nothing to hide.

How do insurance companies conduct surveillance?

Insurers hire private investigators and ask them to find out whatever they can about you. Investigators will follow you, and record your actions through photographs and videotape. Their goal is to get any useful information that can help them deny your LTD or cut off your benefits.

What happens if you lie about an insurance claim?

At best, you will have to remember your lie the entire time you are dealing with your insurer. They will most likely record calls and other interactions with you to uncover any discrepancies in your claim. At worst, you could face criminal penalties leading to fines and even jail time.

Can you go to jail for insurance fraud?

In NSW, insurance fraud is usually dealt with under Section 192E of the Crimes Act 1900. There is a maximum penalty if convicted of a 10-year prison sentence. You may also be required to pay back the amount that was defrauded.

What does a special investigative unit do for insurance companies?

Duties of the Special Investigative Unit An SIU exists as a subset of every insurance company than handles property damage or personal injury claims in America. Your insurance company’s SIU division consists of special claims adjusters who have extensive knowledge regarding insurance claims.

How do insurance companies investigate claims for fraud?

They also use less dramatic tactics to uncover fraud, such as researching claimants’ backgrounds through perusing criminal records, interviewing claimants and any witnesses, inspecting pertinent sites, etc. Investigators may also consult with the insurer’s legal counsel and serve as expert witnesses in court.

Will the SIU investigate my case for signs of insurance fraud?

Now, the SIU will investigate your case for signs of insurance fraud. Insurance fraud is a common problem plaguing the U.S. A person might have accidentally backed into a fence post but say it was a hit and run to receive insurance money to repair the vehicles.

What does a special investigator for the claims force do?

While conducting civil investigations for the claims force, the special investigator may uncover acts that are illegal by local, state or federal law (insurance fraud). They are, in theory, only concerned with discovered acts that affect the ultimate coverage decision by their employer.