Red Flags of Fraud

A large magnifying glass next to a small red flag.

By definition, fraud is “a false representation of a matter of fact – whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed – that deceives and is intended to deceive another so that the individual will act upon it to her or his alleged injury for benefit.” With insurance fraud costing companies billions of dollars each year, it’s necessary to have professional investigators reviewing each case for potential fraud. Claimants that abuse the system will need to be prosecuted with solid evidence collected by an investigative team.

Investigations are vital when red flag indicators are present.  The indicators include, but are not limited to:

  • Claimant’s injury lacks witnesses.
  • Claimant has multiple versions of the accident; details are vague and/or contradictory.
  • Claimant’s Social Security Number and/or date of birth does not belong to him/her.
  • Claimant retains an attorney immediately after filing claim.
  • Claimant’s injury has the appearance of being an older injury, and/or the claimant does not have insurance coverage.
  • Claimant has a history of subjective injuries; lack of memory on prior loss information.
  • Claimant has known financial difficulties.
  • Claimant is unusually familiar with the insurance system and/or claimant’s family members are receiving insurance or disability benefits.

The Brumell Group is known for investigating fraud. By partnering with the Brumell Group, you will receive a full-service Special Investigations Unit (SIU) team to investigate the claimant and determine if the claim they are making is a claim of merit. The team at the Brumell Group will take an in-depth look at the claim, checking for inconsistencies among the statements for areas of deception of each witness and claimant.

Further, we will interview the claimant, employer, witnesses, review records and other services to get a clear picture of the alleged incident. If fraud is present, The Brumell Group will find it. From obtaining statements to solid background checking and more, the Brumell Group knows how to uncover fraud. There is not always an easy solution in adjusting claims; one size does not fit all.