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.
After many years at sea, a pirate decided to retire. Since he had suffered injuries on the job and after a little budgeting, he thought that he should collect on his worker’s compensation insurance.
Do you know how much a bad hire could cost you or your company? It can be tempting for businesses to skip the background investigations in certain situations, but it is never recommended. With nearly half of resumes including some kind of discrepancy, pre-employment screenings are vital for any business that values security, capital and morale.
There is a rise of “negligent hiring” lawsuits in the U.S. The courts are finding that companies, even small businesses, have “duty of care” responsibility to make sure other employees and customers are safe from physical harm and security risks when doing business with you and your staff.
Fraud is a crime that is more costly than most people realize. According to the FBI, non-healthcare related fraud alone is estimated to cost the U.S. over $40 billion a year! Yet fraud and other unethical behavior does not happen randomly. Certain factors must be present to allow most individuals to commit these crimes.
American criminologist Donald Cressey developed a theory – known as the Fraud Triangle – that explains the factors that lead to fraud and other unethical behavior. When businesses and organizations understand the Fraud Triangle, they can more effectively combat criminal behavior that negatively impacts their operations.
The success of properly processing an insurance claim requires due diligence/fiduciary duty as an insurance professional to evaluate each claim by conducting a preliminary investigation. We have found time and time again that using the SIB (Statement, Index [ISO], Background) approach to start an investigation yields the most useful and effective results. Following this preliminary approach ensures the most accurate results are obtained.
With the results obtained from the SIB portion of the claims investigation, we form a partnership that acts on these results in the most appropriate ways, such as investigating red flags more thoroughly, digging deeper into a person or entity’s background forming a plan of action to achieve cost effectiveness.
Fraudulent activity has and always will be an issue in our society. These articles from Miami News date back to 1973 and prove the problem of fraud is timeless — and costly in automotive and medical insurance claims, as well as other areas of profession. Thank you to John Kruzewski for sending our way!
“The Bricklayer’s Insurance Claim” is a hilarious story that shows how “creative” a claimant can be when recalling the events of their claim. Hopefully you’ve never come across a testimonial like this when looking into a workers compensation claim. (Unfortunately, they’re not uncommon.)
What is the most outrageous claim you’ve seen come across your desk? Share in the comments below!
Do you need help deciding if and when you need the help of an investigator? Investigation services are crucial to those with a fiduciary responsibility to ensure that all monies paid are legitimate. Investigative services control costs of a claim by determining the compensability or liability of the claim, mitigation and/or determining fraud.
Spring is in the air! This means Spring break, Easter, Daylight savings time and other opportunities for claimants to go out and enjoy the sunshine. What will your claimant’s children be doing over Spring break? Will there be egg hunts…