3 Tips for Spotting Fraudulent Claims

Most property and casualty claims adjusters will tell you that spotting fraudulent claims is sometimes more difficult than it seems. One case may seem blatantly obvious as fake, while it is in fact completely true. Another might appear to be simple, but really be a part of a larger insurance scam.

So, how do you tell the difference between the two? Here are a few tips to make spotting a fraudulent claim easier.

Ask Questions

One of the easiest ways to spot insurance fraud is by simply asking questions. Request further clarification on anything that seems a little strange or isn’t completely clear. Also, don’t be afraid to ask the same question multiple times over the course of various conversations. If the information is valid, it will often stay close to the same each time. If it is not, there’s a good chance that it will change each time the claimant or insured answers. (Hint: Insurance transcription services can help you easily spot the difference between the two.)

Use a Map

Another way to spot fraud is by simply utilizing something that you already have available to you—the internet. Google Maps and other similar websites are great for looking up the topography of intersections. This can help you determine whether or not an accident statement makes sense or whether it is even possible for a collision to happen in the manner initially described. In addition, understanding the exact layout of where an incident took place can even assist you in making a clear and complete liability decision.

Use Social Media

In today’s society, sharing thoughts and stories on the internet as they happen has become quite commonplace—even for those attempting to commit insurance crimes. Another way to spot fraudulent claims is by taking a peek at the social media profiles of suspicious insureds or claimants. Public photos and status updates often give great insight into whether or not a specific injury claim actually caused harm or if an accident really happened in the manner in which described. Many carriers have found this to be an excellent way to dispel untruthful injury claims and accident reports, simply because the party trying to commit fraud decided to brag online.

Utilize Recorded Insurance Transcriptions

Recorded statement transcriptions can also help you spot a fraudulent claim. How? It is often easier to notice differences in an insured or claimant’s description of what happened when it is in front of you as text. After the transcription process has taken place, compare the conversations to determine if there are any discrepancies. Any obvious differences should be cause for concern and earn a second look by your department’s special investigation unit.

While these are just three of the many ways you can help spot fraudulent claims, there is still one major tool you can rely on—your own instinct. As a claims professional, you know what sounds right for an incident and what doesn’t. Trust that intuition and decide when it is appropriate to dig a little further before settling a claim. After all, the best case scenario is that there is no fraud happening and that you were able to prove so.

© Copyright 2024, Veritext, LLC