An insurance investigator examines
insurance
Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...
claims that are suspicious or otherwise in doubt. Investigators in this field have differing specialties and backgrounds. Some insurance companies have their own in-house investigation teams while other companies sub-contract the work to
private investigator
A private investigator (often abbreviated to PI and informally called a private eye), a private detective, or inquiry agent is a person who can be hired by individuals or groups to undertake investigatory law services. Private investigators of ...
s or private investigation firms. Although such investigations are usually conducted to combat fraud, very often investigators will be working simply to establish the circumstances of a particular claim (for example, in a multi-vehicular
road accident involving various parties, claims and insurance companies).
Insurance fraud
Methods of defrauding insurance companies are manifold, as are the means of investigating them. As a
crime
In ordinary language, a crime is an unlawful act punishable by a State (polity), state or other authority. The term ''crime'' does not, in modern criminal law, have any simple and universally accepted definition,Farmer, Lindsay: "Crime, definit ...
, however, evidence shows that
insurance fraud
Insurance fraud is any act committed to defraud an insurance process. It occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. According to the ...
in wealthy nations is increasing, with many governments running public awareness campaigns to deter potential fraudsters and appeal to the public to report any suspicious claims.
One of the most common forms of insurance fraud is the exaggeration of injuries. Because many injuries can be exceptionally difficult to quantify (for example, psychological injuries or physical injuries such as
whiplash
Whiplash may refer to:
* The long flexible part of a whip
* Whiplash (medicine), a neck injury
** Whiplash Injury Protection System (WHIPS), in automobiles
Film and television
* ''Whiplash'' (1948 film), a US film noir about a boxer
* ''Whiplas ...
), investigators will often seek to establish that what the claimant claims is true (for example, if a claimant states he or she cannot work) and that there are no obvious discrepancies in the symptoms claimed (very often examined in conjunction with medical staff). Surveillance is often employed in such circumstances to verify the claim.
Another form of lesser known fraud is that of claiming on an insurance policy for injuries sustained before the policy came into effect. For example, in a
road accident, a person may claim to have sustained a debilitating back injury. On investigation, however, it transpires that the injury had been sustained in an incident some months or even years before. Very often insurance companies and investigators will study medical reports and history to eliminate this possibility, as well as searching for evidence of previous claims or accidents.
There are also many forms of fraud involving property, for example when a person with valuable assets (property, for example) deliberately destroys them, often through arson, with the intention of then claiming the value back through insurance. Another form would be an art collector insuring a high value piece and then having it 'stolen' - claiming the money for themself and keeping the art piece in the process.
References
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Insurance fraud