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Insurers on the Alert for False Claims Turn to Private Investigators

  • July 12, 2006
  • by PInow Staff

Professional Investigator Warns Insurers to Check Public Records and Surprise- Medical Records for the Real Scoop

Terese Strickland, a professional private investigator in Knoxville, Tennessee has seen some strange insurance claims in her years as an investigator. One that sticks out in her mind is "a claimant who insisted he became diabetic as a result of a car accident." While such cases may bring a chuckle to many people, they are no joke for insurers who lose millions each year as a result of such bogus claims.

Worse, Strickland points out that many cases are not so obvious. Another case this investigator cracked involved a claim of e.coli poisoning. Strickland was able to prove her client, a well-known dairy, was not at fault after discovering that the woman making the claim was lactose intolerant and likely did not ingest milk. This was discovered only after an intensive medical records search an investigation that many insurers resort to all too rarely.

The problem of insurance fraud, though, is a large one and is only growing. A 2003 study by Accenture found that one out of four Americans think it is okay to defraud insurance companies. An even greater number of Americans think it is acceptable to lie to insurance companies if they have been paying the company premiums. According to the National Insurance Crime Bureau over $30 billion is paid out annually in fake claims in the property and casualty insurance industry alone. The fact is, insurers need to be aware of the fact that customers may be defrauding them and feel completely justified in doing so.

Many insurance companies are responding with new attempts to separate legitimate claims from bogus ones. In fact, some studies from the Insurance Research Council have uncovered that spending on insurance investigations increased from $200 million in 1992 to $650 million in 1996 and the numbers have just kept on growing. An increasing number of insurers are hiring private investigators in order to crack down on fraudsters.

Many larger companies are opting for entire units of professional insurance investigators to find and prove faulty claims. These investigators follow up on suspicious claims, find evidence of accidents in cases where claimants (suspiciously) cannot offer proof, and even speak with witnesses. The major advantage to hiring investigation units is that someone is always on call to help in case of a suspicious claim. The problem is that such investigation units are labor-intensive and so tend to be expensive, out of the price range for smaller companies.

For this reason, many insurers turn to private investigators. When hiring private investigative professionals, insurers can select investigators with special experience or expertise and pay only for results. Thats not all professional investigators have extensive experience that can save insurers money and can get superior results. According to Strickland, private investigators can often save companies money by studying medical records and by canvassing hospitals and pharmacies.

"These are useful in determining right from the start the cooperation and truthfulness of the claimant. I first pull a claimant's address history and then contact all local hospitals and pharmacies in order to establish treatment of claimant. This saves time and money," said Strickland.

Strickland, whose investigative firm can be found on the web at www.emedicaltrace.com, also routinely looks through medical records to uncover information claimants may be trying to hide: Medical records contain a lot of often overlooked information including how a claimant describes how they received their injury, drug use, affairs, hobbies, sports and other work the claimant may be performing.

To locate fraud investigation specialists like Strickland Investigations, visit the PInow.com Investigator Directory (http://www.pinow.com). Professional investigators make their listings available on this web site.


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