Insurance fraud investigation Miami Beach South Beach

Technology and social media are great tools used to investigate insurance fraud, according to expert panelists who spoke at the recent Risk and Insurance Management Society conference in Denver. Insurance fraud investigation.

Susan LaBar, a risk manager, and Scott Catron, senior vice president, provided tips for adjusters investigating suspected insurance fraud.

LaBar said she regularly gathers comprehensive information on both workers’ compensation and general liability claims. Insurance fraud investigation. When a claim occurs, LaBar requests a detailed, five-page report. It contains requests for nicknames, email addresses, hobbies, children’s names and hobbies, work history, college information and even pet information. Insurance fraud investigation. This information helps when it comes time to conduct the internet and social media background investigation.

Catron discussed several technologies currently utilized in claims investigations. Insurance fraud investigation. These include 3 D laser scanning, cross-referencing multiple databases, mapping claims, remote surveillance and GPS and black boxes. Insurance fraud investigation. He provided an example where mapping claims helped him discover two claimants that lived on the same street. This helped him when it came time to set up surveillance of the claimants.

Used to monitor vehicles, GPS and black boxes can be can be programmed to provide tire and off route alerts, according to LaBar. In addition, she said they can help verify whether or not a bus was in an area that a claimant claims an accident occurred. Insurance fraud investigation. She added that buses outfitted with surveillance cameras can document hop-on, claimants who hop onto a bus after a crash and claim an injury.

Insurance fraud investigation. Catron explained the difference between a surface search and a deep internet search and provided tips on conducting internet investigations. Insurance fraud investigation. He said a surface search involves using google and other search functions while a deep web search involves searches that lead to other databases, like court websites. Insurance fraud investigation. Catron described how a deep internet search helped him find a regional race track website that contained damning photos of a claimant.

The seasoned investigation warned against friending claimants on social networks. He also emphasized the importance of confirming that the correct person is being investigated. Insurance fraud investigation.

Sometimes claimants can get creative, they said. Insurance fraud investigation. During past investigations both have encountered claimants who had two Facebook pages, one with the alleged injury and one without. Insurance fraud investigation.

When screen shots are used as evidence, Catron said that it is important to note that whoever takes the screen shot will likely have to appear in court. Insurance fraud investigation.

Catron also provided some surveillance tips that adjusters should consider when working with an investigation. Adjusters should be aware that investigations:

Can’t trespass; Insurance fraud investigation.
Can’t zoom into a residence; Insurance fraud investigation.
Can’t film over a privacy fence; Insurance fraud investigation.
Can’t climb trees; Insurance fraud investigation.
Must be in public view; Insurance fraud investigation.
Can’t participate in the hard following (obvious tailing) because it is considered harassment; Insurance fraud investigation.
Can’t extract information by pretexting or lying about who they are. Insurance fraud investigation.

Insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. Insurance fraud investigation. This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due. Insurance fraud investigation. According to the United States Federal Bureau of Investigation, the most common schemes include Insurance fraud investigation. Premium Diversion, Fee Churning, Asset Diversion, and Workers Compensation Fraud. The perpetrators of these schemes can be both insurance company employees and claimants. Insurance fraud investigation. False insurance claims are insurance claims filed with the intent to defraud an insurance provider. Insurance fraud investigation.

Insurance fraud has existed since the beginning of insurance as a commercial enterprise. Fraudulent claims account for a significant portion of all claims received by insurers and cost billions of dollars annually. Insurance fraud investigation. Types of insurance fraud are diverse and occur in all areas of insurance. Insurance crimes also range in severity, from slightly exaggerating claims to deliberately causing accidents or damage. Insurance fraud investigation. Fraudulent activities affect the lives of innocent people, both directly through accidental or intentional injury or damage, and indirectly as these crimes cause insurance premiums to be higher. Insurance fraud poses a significant problem, and governments and other organizations make efforts to deter such activities. Insurance fraud investigation.

Fraud is a problem that can be faced by any cooperation or business. It may take years or decades before it is realized that this is taking place. Insurance fraud investigation. When a lot of people are involved it makes it hard to know what is going on. Insurance fraud investigation. If you are having suspicions and you want to be sure of what is going on in your company, you should hire an investigation. Here are the qualities of a fraud investigation people should consider before hiring. Insurance fraud investigation.

Insurance fraud investigation. Honesty and good morals are some of the important qualities of good investigations. With these qualities, it is easy to trust them, which is important so that you can be comfortable when it is time to share private information in the process of investigating. When they are honest and have upright morals in their conduct it makes it easy to trust them and their work. Insurance fraud investigation.

Insurance fraud investigation. A fraud investigation is someone who investigates forgery and theft within customers’ accounts and transactions on behalf of a bank or a financial institution. Insurance fraud investigation. They track and monitor the bank’s transactions and activity that comes through the customers’ accounts. It is their job to identify and trace any suspicious or high-risk transactions, determine if there is improper activity involved, and determine if there is any risk to the bank or its customers.

A fraud investigation is responsible for observing various customer transactions to flag or identify suspicious activity. Insurance fraud investigation. Most accounts and customers have banking patterns that typically do not change over the long term. Insurance fraud investigation. Any transactions or series of transactions that do not fit the expected activity generate a 'red flag' and will be looked at by a fraud investigation. Insurance fraud investigation.

Insurance fraud investigation. If any suspicious transactions are found, the fraud investigation will flag the account and keep it suspended until it can be checked and verified. Insurance fraud investigation. Transactions can be looked at for any number of reasons: transaction type, transaction amount, unusual transfers to unlikely partners, places where transactions originate, or a flurry of activity beyond the accepted norm for the account. Insurance fraud investigation.

For any suspicious transactions, the fraud investigation (typically an officer of the bank) will try to obtain information that can support the origin of the transaction. Insurance fraud investigation. For fraudulent items, this information can bear out who perpetrated the fraudulent item and is responsible for the criminal activity in question. The analyst will contact the bank branch, the account holder, and any other intermediate parties that may have come in contact with or handled the questionable item. Insurance fraud investigation. They are responsible for keeping any collected information confidential while working to catch the criminal(s) who may have committed the felony. Insurance fraud investigation.

The fraud investigation must also keep models for analyzing fraud within the bank’s regions. Insurance fraud investigation. This can help determine patterns of fraud over certain areas, and break down larger criminal rings responsible for fraud activity. Insurance fraud investigation. This can also help to identify certain holes in security that can be targeted over time so that the bank can identify system improvements that can be made to eliminate the risk of fraud or reduce the ways in which it can occur. The investigation may even have a say in software tools that can work towards detecting fraud and preventing it from occurring or reporting security threats and suspicious activity quickly. Insurance fraud investigation.

Insurance fraud investigation. The typical workplace for a fraud investigation is typically in a corporate office environment if not working as a freelancer. Insurance fraud investigation. The fraud investigation will typically be in a regional or central office, where he or she can monitor activity from multiple sources at once. Insurance fraud investigation. At a moment’s notice, the fraud investigation may be able to access any type of data needed to investigate the troublesome activity. Insurance fraud investigation.

Insurance fraud investigation. A fraud investigation specializes in investigating suspicious activities that could potentially include fraud. Fraud investigations often work with law enforcement officers, and they have an expansive knowledge of finance and relevant computer programs to perform their job. The job responsibilities of a fraud investigation include researching criminal fraud methods and tools, tracking financial data, creating reports, identifying and investigating possible fraudulent activities, and developing techniques and tools useful in the prevention of fraud. Insurance fraud investigation. Fraud investigations are responsible for tracking criminal fraud, which may involve monitoring financial transactions and analyzing the data retrieved for irregular patterns. Fraud investigations work in a variety of industries, but they usually work in a private institution such as a bank. Insurance fraud investigation.

Fraud investigations must continuously educate themselves on the latest advances in the field of fraud prevention, as well as on methods used by criminals to access financial information. New technology is essential for fraud investigations, so they must stay up to date with relevant advances in technology. Insurance fraud investigation.

The educational minimum for most fraud investigation positions includes a bachelor's degree in finance or a related field. Some employers will substitute several years of experience in lieu of a degree. Fraud investigations working with a bank usually receive training from their employer as well. An eye for detail, good problem-solving skills, strong organizational skills, and an analytical mind are essential. Insurance fraud investigation. Excellent oral and written communication skills are necessary, as they are often required to interact with customers and other stakeholders on a regular basis.

In any investigation, research is crucial, when looking for an investigation, you should ensure they have quality research skills. Insurance fraud investigation. They should be experts at gathering information. They should also be able to do this in a strategic manner and carefully evaluate it before they present their findings. Insurance fraud investigation. This will help the investigation to be completed within a short period of time and will also save the client money. Insurance fraud investigation.

Knowledge of the law and that of the legal area that the detective is working on is very important. Insurance fraud investigation. This includes the ability to handle witness statement, a theft case at the company and a combination of various legal areas in a fraud case. Insurance fraud investigation. He or she should also be licensed, find out if they are at the office of your commissioner.

A good relationship between the investigation and the client is important. Insurance fraud investigation. Good communication will help in developing a good relationship between the two of you. The detective should be able to communicate effectively with you as the client and also with the staff involved. Insurance fraud investigation. The fact that the individual is a representative of you, it is important that he or she be courteous when conducting the investigation. Insurance fraud investigation.

The skills and knowledge that the investigations must have in the investigation field should be exceptional and of high level. They must be able to perform at their level best the task you present to them. Insurance fraud investigation. They should have done an on the job training; a course certificate is not enough to give them exposure to the detective field. The training helps in gaining knowledge of new skills and helps them advance their existing ability. Insurance fraud investigation.

Experience is good in the investigative field, even with the course certificate and training, the experience is important. Insurance fraud investigation. An investigation who has spent a lot of time in one field has enough knowledge and understanding. Insurance fraud investigation. That is why an experienced person is more likely to save you time and money because of their familiarity with the work. Insurance fraud investigation.

After the investigation is complete you want quality findings. To ensure that you have this you must find the right person to do the job for you. Insurance fraud investigation. You should find someone who you can trust. Insurance fraud investigation. Even though you will be looking for the best qualities you should trust your judgment at all times, at the end of the day you want someone you are comfortable with. Insurance fraud investigation.

Insurance fraud investigation. Whether you are a policyholder or a shareholder in an insurance company, insurance fraud affects you. Insurance fraud investigation. The field of insurance is wide and fraud exists in every area. Therefore, in this article, we are going to focus in on one of the most important types of insurance – life insurance. We will look at the major types of life insurance fraud and how they affect your bottom line. Insurance fraud investigation.

Insurance fraud investigation. Insurance fraud comes in two main categories: seller fraud and buyer fraud. Insurance fraud investigation. Seller fraud occurs when the seller of a policy hijacks the usual process, in a way that maximizes his or her profit. Buyer fraud occurs when the buyer bends the process to obtain more coverage, or claim more cash than he or she is rightly entitled to. Insurance fraud investigation.

Insurance fraud investigation. Almost everyone is familiar with insurance fraud. We've all heard the stories of people who received millions after a car accident or the heartless insurance firm refusing to pay out to a widow on a technicality. Insurance fraud investigation. Insurance fraud is one of the oldest types of fraud ever recorded, dating back to 300 B.C., when a Greek merchant sunk his own ship, in an attempt to cash in on the insurance, and drowned in the attempt. Insurance fraud investigation.

It Takes Two to Tango Insurance fraud investigation.

Insurance fraud investigation.

Insurance fraud comes in two main categories: seller fraud and buyer fraud. Seller fraud occurs when the seller of a policy hijacks the usual process, in a way that maximizes his or her profit. Buyer fraud occurs when the buyer bends the process to obtain more coverage, or claim more cash than he or she is rightly entitled to.

Types of Seller Fraud. Insurance fraud investigation.

Insurance fraud investigation.

There are many variations of seller fraud, but they all center around four basic types. These are:

Ghost Companies: In the ghost company scenario, policies are issued and premiums accepted from policyholders, but the company underwriting the policy isn't legitimate and often doesn't exist. Insurance fraud investigation. These outright frauds are a type of boiler room operation, where a team of high-pressure scam artists dials likely victims to sell them false policies. Insurance fraud investigation. Unfortunately, the fraud isn't usually discovered until someone tries to file a claim on the policy their family member thought was in effect, in the event of his or her death. Insurance fraud investigation.

Insurance fraud investigation. Premium Theft: The premium theft scenario is when the insurance rep accepts premiums, but doesn't submit them to the company underwriting the policy, thus invalidating the policy. In this case, the agent essentially pockets the money. Insurance fraud investigation. Premium theft has become less of an issue as more companies have moved towards direct deposit models, but it is still possible in some cases. Insurance fraud investigation.

Churning: Churning refers to a situation where the insurance rep advises the customer to cancel, renew and open new policies in a way that is beneficial to him or her, instead of beneficial to the client. Insurance fraud investigation. This type of insurance fraud often targets seniors and is driven by the agent's desire for larger commissions. Insurance fraud investigation. Churning keeps a portfolio constantly in flux, with the primary purpose of lining the advisor's pockets. Insurance fraud investigation.

Over or Under Coverage: Insurance fraud investigation. Similar to churning, under or over coverage occurs when an insurance rep convinces customers to buy coverage they don't need, or sells a lesser policy and represents it as a complete policy. In either case, the rep is trying to maximize commissions and ensure the sale, rather than focusing on meeting the client's needs. Insurance fraud investigation.

Types of Buyer Fraud Insurance fraud investigation.

Buyer fraud also comes in a number of different flavors, but they all center around a theme of dishonesty. Basic types of buyer fraud include:

Post-Dated Life Insurance: Post-dated life insurance refers to a policy that has been arranged after the death of the person being insured, but appears to have been issued before death. Insurance fraud investigation. This type of fraud is usually carried out with the help of an insurance agent. It is also one of the easier types of fraud for insurance companies to detect because record keeping has become more stringent. Insurance fraud investigation.

Insurance fraud investigation. False Medical History: Falsifying medical history is one of the most common types of insurance fraud. By omitting details such as a smoking habit or a pre-existing condition, the buyer hopes to get the insurance policy for cheaper than he or she would have otherwise been able. Insurance fraud investigation.

Insurance fraud investigation. Murder for Proceeds: Insurance fraud investigation. There are two versions of the murder for proceeds fraud. In the first, the insured doesn't know they are insured and are understandably surprised to be murdered. Insurance fraud investigation. In the second, the policy is legitimate and was taken out in better times, however, financial hardships lead the perpetrator to decide that killing his or her spouse/family member/business partner, for the money, is the best way out of the problem. Insurance fraud investigation.

Insurance fraud investigation. Lack of Insurable Interest: As with murder for proceeds, ensuring people you shouldn't be insuring, in hopes that they will die, constitutes fraud. Insurance is founded on the idea of protecting people from financial loss, so using it to gamble on lives for a financial gain is a perversion of the system. Insurance fraud investigation. This includes viatical settlements, which combine non-insurable interest with falsified policies taken out on the terminally ill. Insurance fraud investigation.

Insurance fraud investigation. Suicidal Accidents: Just as financial hardship can lead otherwise rational people towards murder, the same factors can lead people to commit suicide in a way so it looks accidental. Insurance fraud investigation. This constitutes fraud in that it is an intentional act for the purpose of collecting the insurance proceeds, and would not have occurred if those proceeds did not exist. Insurance fraud investigation. This can be a very difficult one to detect, as the medical examiner has final say in accidental death. Even if it is clearly a suicide, the claim centers on the state of mind, rational or not, at the time of suicide. Insurance fraud investigation.

Insurance fraud investigation. Faking Death or Disability: Many life insurance policies have riders for disability, creating the temptation to fake one to get the payout. However, some people take it a step further and fake their own deaths. Insurance fraud investigation. In both cases, the fraudster has to deal with the possibility of being discovered through an investigation. Insurance fraud investigation.

The Cost of Insurance Fraud Insurance fraud investigation.

Just as there are two main types of life insurance fraud, there are also two consequences. When people engage in buyer fraud, it raises the cost of insurance. Insurance fraud investigation. The reason for this is very simple; insurance companies are really good at modeling, so they tweak their models to account for buyer fraud and then spread that cost across all their policyholders. In a very real way, every person who tries to stick it to the insurance company ultimately makes your policy cost more. Insurance fraud investigation.

Insurance fraud investigation. In contrast, seller fraud can potentially hurt just the select few that experience it. It is, in every essence of the word, bad luck. Insurance fraud investigation. However, on the whole, every time the insurance company you invest in treats someone badly, it loses business to a company with a better reputation and controls on the agents. Insurance fraud investigation. As an investor, you will be tempted to move your capital to the better performing company, thus punishing seller fraud in a roundabout way. Insurance fraud investigation. The internet has also helped reduce seller fraud, as many shady outfits and practices become exposed sooner in the game. Insurance fraud investigation.

The Wasser Agency located in Miami, FL offers you all type of resources you need to carry on any investigation with a variety of specialized human resources (investigations) in many fields. Insurance fraud investigation.

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