The Role of an Insurance Investigator

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The Role of an Insurance Investigator

Fraud is just one of the major problems companies face on a regular basis. Insurance fraud refers to any instance in which a claimant tries to obtain a benefit or advantage they aren’t entitled to, which typically leads to monetary payment. From false worker’s compensation claims to staged accidents and more, insurance fraud is not at all a victimless crime, impacting thousands of small businesses and individuals alike.

Insurance fraud is not at all a victimless crime, impacting thousands of small businesses and individuals alike.

Luckily, there are steps that can be taken to ensure your clients don’t fall victim to a suspicious claim — by either an individual or an insurance company. Learn how private insurance investigators can help assist your law firm and clients by investigating false claims. 

Insurance Fraud Statistics 

According to the Coalition Against Insurance Fraud, insurance fraud steals approximately $80 billion each year from American consumers, and Medicare fraud can cost nearly $60 billion a year. According to the FBI, insurance fraud can drastically increase premiums for American families, increasing their yearly premium spend by $400-$700. Unfortunately, this type of fraud continues to be prevalent. In fact, according to U.S. insurance statistics, it’s estimated that 18 percent of all insurance claims indicated some level of fraud. 

Types of Insurance Fraud

There are a number of different types of insurance fraud, and many different behaviors that could qualify as fraudulent. Below is a list of insurance fraud that is most commonly committed, according to  These types of fraud can typically be classified into the following categories: auto, life and disability, homeowner, agency/industry, health insurance fraud and worker’s compensation. 

Asset diversion:  Asset diversion refers to the theft of diverting funds owned by an insurer. This can typically happen during a business merger, or other acquisitions.

False or inflated theft claims: This is likely one of the most common types of insurance fraud. Any instance that is exaggerated or inflated can be considered fraud, and of course fabricated claims regarding an accident is also fraud, and is common in auto insurance claims. 

Fabricating incidents and incident details: Even if an accident or claim did occur, fraud can still be evident if the information provided within a report is not entirely correct. This can also include providing incorrect dates and locations in incident reports, or being at-fault for the accident (for example, committing arson that causes a house fire). 

Fake death or life insurance claims: Tampering with life insurance policies or policy misrepresentation for personal gain is unfortunately a very commonly committed form of fraud.

Churning: Churning refers to when an insurance agencies falsify information in an effort to convince a customer to purchase more expensive insurance policies. 

How Insurance Investigators Detect Fraud 

Private investigators are an excellent resources for law firms looking to obtain proper evidence in a possible fraud case. Learn more about the different methods in which insurance investigators detect and prove instances of fraud. 

Validating information: During an investigation, insurance investigators will review all documents in question meticulously to validate that the information recorded is accurate, and to review any discrepancies that may arise. An insurance company typically has its own department to review potentially fraudulent claims, but a private investigator can go the extra mile to obtain more detailed information.

Conduct interviews: Private investigators are experts at interrogation and are likely to uncover more evidence of crimes, especially if there are multiple discrepancies during the interview process. Typically, private investigators have experience in law enforcement or other relevant previous career experience that allows them to easily locate witnesses to prove or disprove the facts presented. 

Surveillance and gathering evidence from crime scenes: Surveillance is a huge benefit of hiring a private investigator, as they can complete this ethically based on federal and state guidelines. An insurance investigator will exercise caution recording suspects and observing a claimant under surveillance.

Developing documentation for trials: Should a fraud case result in the need for a trial, insurance investigators can be a huge asset in developing vital documentation to be used in the courtroom. These trained individuals are aware of all of the legal implications of evidence gathering, insuring that the information provided is admissible in court. 

Work with a Private Investigation Company 

Do you suspect your client has fallen victim to fraudulent claims? We can help. InQuest Solutions offers over 20 years of experience stopping fraud in its tracks. We are committed to customer satisfaction, outstanding customer service and excellence, serving the insurance, government, legal and business communities. InQuest is well-versed in servicing the insurance industry, and we’ve established ourselves as a leader due to our attention to detail and responsiveness.

At InQuest, we are aware of the pressure and time constraints within the claims industry, which is why we prioritize delivering information our clients need on time and within budget to help our clients — and theirs — mitigate fraud. With 24 hour access to our secure case management system, you can receive updates, reports, documents and video to assist you with your insurance investigation. We specialize in physical surveillance and activity checks, social media and online mining, medical, gym and pharmacy canvassing, background investigations, special investigation unit services, and fraud and theft investigations. We can help bring you bring a suspect to justice.

Contact us to submit a free new case request.

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