Preventing And Detecting Insurance Fraud
Protect yourself from insurance fraud where it might affect your insurance coverage and benefits in health, medical and auto. Find out how insurance fraud investigation works.
Insurance Fraud...Consumer And Company View
* Consumer Activated Claims. Insurance fraud takes many forms. The consumer view of insurance fraud typically assumes the failure by large insurance firms to satisfy their insurance coverage obligations relating to health or medical or auto or perhaps life insurance policies.
In consumer actions taken related to health, life, medical as well as car insurance policies, insurance fraud claims against insurance firms focus typically upon improper claims processing, or delays or outright denial of payment for qualifying claims.
* Initial Investigation. An insurance fraud attorney commence the background investigation in order to quickly determine the factual basis and recommend prompt settlement of valid qualifying claims requiring financial settlement.
Equally important, these insurance fraud lawyers will recommend that insurance firms "go to the mat" in defense of non-payment for unjustified claims, or where a policy holder is engaged in attempted insurance fraud.
The parties develop their separate insurance fraud case arguments and then commence the formal dispute. The policy holder claims " foul play" and insurance fraud, whereas the corporate managers shield themselves behind administrative procedure and corporate policy until the attorneys can settle the insurance fraud charge short of proceeding through the courts.
* Where Policy Holders Engage In 'Foul Play'. The insurance fraud report also reflects situations where policy holders attempt to bilk or defraud insurance firms through fraudulent claims, falsifying accidents and damage estimates, conspiring with service repair vendors to alter insurance reports or to inflate bills, or producing phony records alleging damages and losses on property and theft policies.
In these instances, it is legal and necessary for the insurance firm to aggressively prosecute the counter-claim of insurance fraud perpetrated by the policy holder.
* Risk Versus Reward In Many Forms. The insurance fraud investigator recognizes that the key to unraveling fraud is to recognize that the crime is a multi-point concept which, like insurance itself, reflects a complex risk and reward environment.
In the proper environment of law-abiding firms and policy holders, insurance fraud is minimized due to the collaborative relationship of risk and reward set up when policies are formulated. However, in the event that an insurance firm shifts policy and becomes confrontational, then policy holders will be tempted to conclude that a cover up, an unwarranted denial of a qualifying claim, or insurance fraud is being perpetuated at the direct cost of the insured party.
* Situations Where Policy Holders Are Defrauded By Identity Theft. A less common event is where an insurance fraud investigation occurs due a policy holder becomes the victim of identity theft.
In this situation, criminal access to personal and confidential files and policies could result in insurance fraud, where the insurance firm is fraudulently induced to payout loans against accumulated policy values.
* Value Of Court-Awarded Claims - Appeals Process. Insurance fraud counsel will occasionally intercede where juries have ruled for punitive damages awards that are excessive. In these instances, the appeal process does not dispute the underlying insurance dispute between the firm and its customers, rather attempts to set fines or awards at levels which are reasonable and appropriate, and which will not cause financial ruin to the insurance firm and its public shareholders.
* What To Do If You Suspect 'Foul Play'. In the event that you suspect that you've become a victim of insurance fraud, then you should immediately assemble all related documents and correspondence and phone logs and deliver these materials to a competent insurance fraud attorney for development of your case argument.