People who have intent to do harm always come up with creative ways to bypass security and sometimes common sense. They are smart, technology savvy, and can keep up with trends which makes it difficult to catch them in the act. There are tons of scams out there causing Americans billions each year- insurance claims are but one of them. Because of the pandemic, there are more of those who are desperate to earn a little cash. Their styles and approach can look so genuine and realistic, which is why your clients need to be wary and trust their instincts.

The first step in getting ahead of their game is to be aware of the ways they can manipulate your clients. If they are aware of the ways they do it, you can steer clear or identify a scheme from the start. Insurance adjusters are usually quite skillful in spotting anomalies. Otherwise, submitting a fraudulent insurance claim can result in paying a huge penalty, or worse, getting involved in legal suits. Especially now that insurance claims are skyrocketing, here are some ways your clients can stay out of hot water.

Review the Claims History

Look for patterns. How many claims have been submitted so far? How often does this happen? How much do the total losses amount to? Review past claims and analyze the trend carefully. 

Watch for Suspicious Loss Indicators

Unknown to many, the National Insurance Claim Bureau (NICB) exists and maintains a list of 23 behaviors that usually suggest a fraudulent claim. The scam experts are probably aware of the list, but first timers aren’t particularly well informed of them. Have your clients review the list above to get familiar with signs of fraudulent insurance claims.

Find Evidence of Fraud in Various Sectors

Lawyers and medical practitioners have taken part in fraudulent insurance claims as well. Medical practitioners declare injuries that are nonexistent and bill them to insurers. Lawyers then encourage negotiations to commence for a settlement based on these nonexistent injuries. The people who frequent this type of scam are easily caught because insurers notice a pattern of claims from the same institution and treatment regimen.

Spot Billing Inconsistencies 

Computer systems are now being used to identify shady billing statements. In the medical field, practitioners submit receipts for treatments that never occurred or weren’t necessary. They also may “unbundle” certain treatments in order to increase the charge submitted for the same service. For these types of claims, insurance agents should ensure that the billing is reviewed and deemed accurate before approving.

Analyze Social Media Activity

How consistent is the insured’s story? Check recent activity in social media and see if there’s any evidence that could be gathered from the insured’s posts, stories or videos. Validate the claim against their posts. There are those who unknowingly create evidence against themselves. People could be more truthful in sharing their successes and be more genuine in their stories when they think they share private (versus public) information online. 

The only way to remain unscathed from a potential scammer’s threats and attempts is by being aware of their modus operandi and knowing how to go about the situation once the approach and purpose are recognized. Due to the pandemic, there are those who would resort to devious ways in order to come up with additional funds. 


About PL Risk

In addition to bringing you the latest news from the insurance industry, PL Risk provides Resources for Agents and Brokers nationwide. We’ve recently implemented Hiscox Now, which allows agents their own access to Hiscox and instant quoting. To learn more about our operations, contact us today at (855) 403-5982.

DOWNLOAD APPLICATIONS

FILE A CLAIM

CLAIM SCENARIOS

FAQs

INDUSTRY TOOLS

FREE CYBER HOTLINE

GET APPOINTED

E

PRODUCTS OVERVIEW

Errors & Omissions

EPLI

Directors & Officers

Fiduciary Liability

Commercial Crime

Cybersecurity

TITLE AGENTS &
MORTGAGE BROKERS

REAL ESTATE

LEGAL

MEDIA

ARCHITECTS & ENGINEERS

FINANCIAL INST.

CONSULTING

MISC. SERVICES

HEALTHCARE
MEDICAL

INSURANCE

TECHNOLOGY

Our Team

Our Charity