How Do Insurance Adjusters Spot Insurance Fraud Cases?


Quick Answer

Insurance adjusters spot insurance fraud cases by analyzing the claimant's claims history and looking for irregularities in personal data. They also look for inconsistencies in police and witness reports of crimes or traffic accidents. In addition, claims adjusters look for "suspicious-loss indicators," which are indications that a claim may be fraudulent.

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Full Answer

Insurance adjusters pay attention to the claims history of a claimant. Anyone who has made a lot of claims, especially with regards to auto or homeowners insurance, is likely to come under close scrutiny. In addition, if a claimant seems to know too much about the insurance claim process or if they change their story regarding the loss, adjusters may suspect fraud.

Adjusters also become suspicious if a claimant's contact information looks irregular. If the claimant's address turns out to be someone else's address or a post office box, or if information regarding tehir employer or personal identification doesn't check out, the adjuster may suspect fraud.

Suspicious-loss indicators that tip off a claims adjuster of possible fraud include claims submitted just after purchasing insurance coverage, handwritten receipts for repairs, fire-damage claims started after an argument within the home and medical claims by employees about to leave their jobs. In addition, claims adjusters are suspicious of claimants who have suffered a large loss but appear completely calm about it.

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