There are times when claims rise to a higher level of exposure and complexity and our investigators have extensive experience in SIU work, where there is suspicion of prosecutorial fraud and other felonies. Every investigation worked, is done through the eyes of detecting potential fraud.
Insurance Fraud is not limited to one group, race, or gender. It is an equal opportunity crime that can be performed by an insurer or an insured.
Insurers must train their staff in identifying the red flags of insurance fraud schemes.
In the constantly changing, growing and highly competitive world of business today, companies need solutions, and these solutions need to be delivered with a focus on accuracy and efficiency. Our SIU has a highly diversified array of services designed to meet your insurance and corporate needs, allowing you to focus on that which your company excels at.
Quality investigations are essential in fighting fraud and no amount of technology can serve as a substitute for the knowledge and experience of a good investigator.
The cost of insurance to consumers continues to grow each year due to the huge losses that occur within the insurance industry. Most carriers can only estimate what they lose to claims that are discovered to be fraudulent.
The adjuster should begin the investigation with a detailed statement from the insured. It is preferable to record the statement. More detail and clarity can be received in a recorded statement than in a written statement.
The recorded statement is easier to take, because writing notes is unnecessary and continues eye contact can not be maintained with the interviewee.
From the insured, the investigator will determine the elements of the accident that brought about the claim.
Our SIU, will meet with the claimant to obtain his or her side of the story as to how the accident occurred. If the claimant is represented by counsel, the investigator will communicate only with the attorney. Our SIU will make the appointment with the attorney to take the claimant’s statement, and the attorney must be present for the interview.
A recorded statement from the claimant is essential. SIU, will have the claimant answer the same questions asked of the insured. During the interview, SIU will not allow the attorney to answer the questions.
Our SIU will also interview each witness, and if they are willing, obtain recorded statements from them. If witnesses are unknown or unidentified, the investigator will visit the scene of the accident and interview people who may have been witnesses.
Depending on the severity of the incident, SIU will take photographs of the scene of the accident showing what, and where the accident occurred. The photographs will also show all damage, and (if applicable) skid marks on a road surface.
Insurance fraud exists when individuals attempt to profit by failing to comply with the terms of the insurance agreement. Fraud can occur at any stage of an insurance transaction by any of the following:
Individuals applying for insurance | Policyholders | Third-party claimants
Professionals who provide services to claimants
The cost of insurance to consumers continues to grow each year due to the huge losses that occur within the insurance industry. Most carriers can only estimate what they lose to claims that are discovered to be fraudulent. Insurance fraud is not limited to one group, race or gender. It is an equal opportunity crime that can be performed by an insurer or an insured.
