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.
Cutting Through Complications
Many times, the Division of Insurance Fraud (DIF) becomes overwhelmed with claims that make no sense. Unorganized pieces and presentation of information results in an investigation halted in its tracks, and often not ever presented to the State Attorney’s Office.
Brumell Group’s analysis process follows specific protocols that helps effectively close cases. A Case Analysis™ conducted by the Brumell Group is a comprehensive report detailing the evidence of a claim along with recommendations on how to proceed. A Case Analysis is always performed by a Certified Fraud Examiner, which results in a clean and orderly final product. Due to the complexities involved in completing a Case Analysis and the multiple activities involved, it may take weeks from the start of the investigation until the final report is complete. Our goal is to get this report completed as quickly as possible without overlooking any invaluable piece of content that could aid with the handling of each claim suspected of fraud.
Through Brumell Group’s processes, all components of the case are adequately addressed as our Case Analysis is put together. If enough evidence is found, our Certified Fraud Examiner will discuss with the client the level of fraud indicated, which is based on the amount of evidence that exists. The next step in the process is sending a “perfectly packaged” filing to the DIF.
What Sets Us Apart
At Brumell Group, we have four key characteristics that sets our firm apart. We are able to successfully bring cases before the DIF because of our:
- Law enforcement backgrounds and ability to compile “probable cause” elements
- Involvement in the fraud task force
- Relationship with the Department of Insurance Fraud and other fraud bureaus throughout the nation.
- Many successful presentations and prosecutions due to our thorough Case Analysis
Compiling the Evidence
In civil cases, the goal is to prove the preponderance of the evidence. In a criminal case, there is a responsibility to prove guilt beyond a reasonable doubt. This is why we take such pains in the collection and presentation of data through an in-depth Case Analysis report.
In order to compile the evidence to present to DIF for presentation and prosecution, we conduct an in-depth examination of all documents pertinent to the claim, from the claim notes through the investigations.
Through our proprietary Case Analysis process, we are able to significantly increase the likelihood that a fraudulent claim will be presented and prosecuted. It’s important to remember that we approach each case on an individual basis. By partnering with our clients, we are able to pinpoint cases that clearly outline potential fraud.
To see how Brumell Group can help your company fight fraud and save money on your bottom line, contact us today at (877) 760-0170