Q:

How do insurance adjusters spot fraudulent claims?

A:

Quick Answer

One of many ways insurance adjusters spot fraudulent claims is to check the insurance history of the claimants. Submitting numerous claims during a lifetime raises red flags. Adjusters also are suspicious if a person claims a lot of losses.

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Full Answer

Insurance companies keep extensive records and consult them to look for unusual patterns. Due to incidents of auto-claim scams, insurers look for evidence of personal-injury mills and false injury claims.

Billing fraud is another area where insurance adjusters are vigilant. While many billing-fraud cases stem from medical providers filing false claims, this type of fraud is also committed by unscrupulous car-repair shops. To combat billing fraud, adjusters use sophisticated computer systems to make price comparisons. Once the adjuster sees what honest vendors are charging for services, inflated claims are easier to spot. Another tool insurance adjusters use to investigate suspicious claims is social media. Adjusters visit popular social-media sites looking for content posted by claimants that strongly hints claimants are engaged in fraud.

Some insurers utilize the services of special investigative units who perform in-depth investigations, computer simulations, analysis and tests to uncover fraud. An investigation may involve checking to ensure injuries are consistent with a reported accident. Another investigation may involve conducting financial background checks on claimants to look for financial problems.

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