SIUs - Perception & Reality With new state mandated compliance regulations, Special Investigative Units (SIUs) are utilized to fight and expose fraud -- whether it be internally or to partner with an external source.. But SIUs are not what many…
Every corporation has a number of internal components that need extra scrutiny, and workers’ compensation fraud is one of these important components. Even as the economy seems to be on the rebound, this form of fraud continues to rise, which puts a strain on everyone involved.
Did you know that insurance companies have, in good faith, a fiduciary duty to report fraud to the state if they suspect fraud is being or has been committed? FL Statutes Ch 626, Sec 989(6) says:
“…any insurer, agent, or other person licensed under the code, or an employee thereof, having knowledge or who believes that a fraudulent insurance act or practice…is being or has been committed shall send to the Division of Insurance Fraud a report or information pertinent to such knowledge or belief…”
There are two basic ways to report this type of fraud: as “Information Only” or as “Fraud”. The evidence collected determines the most appropriate way to file the claim.
Recently, more companies are seeing the true value of using a Special Investigative Unit (SIU) and are recognizing the many different benefits that they provide. In fraud claim handling, they are now essential, both from a cost savings and educational…
When it comes to fraud consulting, SIU management, compliance and investigations, it’s important to remember the high place that ethics and principles have in the process. At the Brumell Group, we consider ourselves in good company in this respect. Across the board, independent investigation firms just like ours are working diligently to ensure that justice is an attainable goal and fraud is accurately caught.
At our firm, we have a core list of these principles that we live and work by. Although these principles may be common in our industry, they are very personal to us, and we take them seriously.
Catastrophe fraud occurs when there has been a natural or man-made disaster. Those that are insured need help quickly, and insurance companies respond fast to all claims to ensure the safety and wellness of the people they cover. Catastrophe fraud comes in several forms, but essentially it means that people are taking advantage of insurance companies when a natural or man-made disaster occurs.
We provide a unique service for Adjusters and Litigation Specialists; our Case Analysis™. A Case Analysis™ is conducted by a Certified Fraud Examiner who reviews all documents and information related to a claim to evaluate and detect "Red Flag" indicators of…
First, let us look at how fraud is defined:
- Fraud is both a crime and a civil law violation. In criminal law; fraud is the offense of deliberately deceiving another in order to damage them. To obtain property or services unjustly. Fraud can be accomplished through the aid of forged objects. It may be called “theft by deception”, “larceny by trick,” “larceny by fraud and deception” or something similar.
- A deception practiced in order to secure unfair or unlawful gain. Any act, expression, omission, or concealment that deceives another to his or her disadvantage; specifically, it is:
– A misrepresentation, omission or concealment of some fact material to a transaction.
– It is made with knowledge (or the reasonable expectation that the perpetrator should know) that it is false or is made in reckless disregard of its truth or falsity.
- It is made with the intent to deceive another.
- It is reasonably relied on by the other who is thereby injured.