Insurance fraud occurs when any act is committed with the intent to fraudulently obtain some benefit or advantage to which they are not otherwise entitled or someone knowingly denies some benefit that is due and to which someone is entitled, also known as a Krut. False insurance claims are insurance claims filed with the intent to defraud an insurance provider.
Accident Claim Fraud
Nomadic individuals are obtaining (possibly from vehicle break ins/ unlocked vehicles) auto insurance policy information. The individual is then calling the insurance company acting like they are the insured. This individual will report the accident, admit that it was 100% their fault, claim no damage / minor damage to their vehicle, and state that the vehicle they struck has damage. The individual will provide the other driver’s information to the insurance company, or the claimant driver will call the insurance company. The claimant driver is either the person claiming to be the insured, or another nomadic individual. Damage to the claimant vehicle may be pre-existing, or damaged is caused.
Elder Bump: auto vs pedestrian
It usually happens in a parking lot. The pedestrian claims that the elderly driver backed up and struck him/her while (s)he was walking. The pedestrian goes to the hospital on his/her own claiming headaches, nausea and soft tissue damage. The pedestrian pushes for direct early settlement. The ID is often false and (s)he may use an associate as a witness. The hospital is never paid.
Life Insurance Fraud
- Life insurance fraud results in some of the largest individual losses to insurance companies. Those costs are, as usual with any type of theft, passed on to honest customers.
- Life insurance fraud is complicated and quite often involves insider involvement.
- Applications are completed with false information such as false names, false dates of birth, false identifications, and false medical history. Look for the same doctors, funeral homes, and policy owners on suspicious claims.
- The claimants will know the limits that would trigger an investigation. Staying below the threshold amount prevents the requirement for a medical exam. The age for the claimant is just under the cut off age for a large policy.
- Organized criminal organizations use an unscrupulous broker to assist in applying for the insurance policies. Quite often, the agent, medical doctor, and funeral home are involved in the conspiracy.