Insurance fraud is a persistent problem that affects insurance companies like IAG, Suncorp, QBE, and Allianz. It involves individuals or groups attempting to deceive insurers by misrepresenting facts, exaggerating losses, or even fabricating events to claim insurance payouts illegitimately.
This could be anywhere from a few thousand to hundreds of thousands of dollars. National Inquiry Agency is often engaged as a crucial line of defence, as private Investigators save insurers substantial sums of money by picking up on this dishonesty and helping insurers deny illegitimate claims.
Insurance fraud is an expensive problem with consequences that ripple throughout the industry. These fraudulent claims drive up insurance premiums for honest policyholders, siphon resources away from legitimate claims, and undermine the trust that policyholders have in their insurers.
In Australia, insurance fraud has been estimated to cost up to $2.2 billion every year. About 10% to 20% of insurance claims are fraudulent. Insurance agencies have found that policy holders commit $35.1 billion in fraud by lying to insurers when taking out a policy in order to get a lower rate for their coverage.
The Role of Investigators
Insurance investigators are skilled professionals trained to detect fraudulent claims through various means. National Inquiry Agency private investigators come from various walks of life. We are made up of ex-military personnel, ex-police officers, qualified lawyers, and legal administrators.
Our responsibilities include:
- To scrutinize insurance claims, comparing the information provided with policyholder records and any relevant documentation. Discrepancies or inconsistencies often raise red flags.
- Investigators delve into the Claimant’s background, searching for any history of fraudulent claims or criminal activity. This can help identify serial fraud.
- Investigators will interview witnesses, such as medical professionals, police officers, and other involved parties, to verify the events leading to the claim.
- In cases of suspected fraud, investigators may conduct surveillance to gather evidence that contradicts the Claimant’s assertions. This can include video footage or photographic evidence.
- We utilise data analysis techniques to detect patterns of fraud within claims data. These patterns can help uncover organised fraud rings.
- Investigators are skilled at identifying inconsistencies in a claimant’s story. For instance, a claimant might report a serious injury that prevents them from working, but social media posts or surveillance footage may show them engaging in physically demanding activities.
- Investigators are skilled at distinguishing between legitimate damage and exaggerated or fabricated claims. They rely on their expertise and site inspections to verify the extent of the damage and whether the damage is appropriate for the claim.
- Investigators scrutinize all submitted documents, looking for inconsistencies, forged signatures, or doctored invoices that may indicate fraud.
- Investigators compare the claimed damage to any pre-existing conditions on the property. Claimants attempting to hide existing damage or falsely attribute it to a recent incident can be exposed through careful inspection
What if we catch someone out?
When investigators successfully uncover fraud, insurers take action to mitigate their losses. These actions may include:
Denial of Claims: The fraudulent claim is denied, and the policyholder receives no payout. This not only saves the insurer money but also serves as a deterrent to others contemplating insurance fraud.
Legal Action: Insurers may pursue legal action against fraudsters to recover funds paid out on fraudulent claims. This can result in criminal charges and civil penalties.
Policy Cancellation: In some cases, insurers may cancel the policy of the fraudster, making it difficult for them to obtain insurance in the future.
These are great outcomes for insurers.
The work of investigators at National Enquiry Agency is an essential part of maintaining the integrity of the insurance industry and ensuring that insurance remains a reliable financial safety net for those who genuinely need it.
If you require a private investigator for this purpose, please reach out.