AUTO CLAIMS FRAUD RED FLAGS

             AUTO CLAIMS FRAUD RED FLAGS
By Robert Carper

The two kinds of fruad you will enciunter are:

       Soft Insurance Fraud. Soft insurance fraud (also called “opportunistic” insurance fraud) is the most common type of insurance fraud. Soft insurance fraud occurs when the claimant makes an inflated claim, such as exaggerating the severity of a car accident neck injury.

       Hard Insurance Fraud. Hard insurance fraud (also called “premeditated” insurance fraud) occurs when the claimant devises a way to make an insurance claim. This type of insurance fraud usually involves some sort of deliberate action, such as intentionally causing an accident or staging arson or theft of the vehicle.

Initial Claim

   ·    There are multiple occupants in the claimant vehicle.

     ·  Accident within a month of the termination of the policy.    

   ·    A rental vehicle is involved.

   ·    Accident occurred shortly after one or more vehicles.
         ·    Insured insists that claimant caused the accident, such as by stopping suddenly, for no apparent reason.

·     Accident is at low speed with minor physical damage, yet there are multiple bodily injury claims.

    ·     One or more claimants list a P.O. Box or a motel/hotel as an address.

·     Claimants immediately seek attorney representation.

   ·     Address of attorney, auto body shop, doctor, etc., are an unusually long distance from claimant's residence address or work location.

·     Accident occurs at an odd hour, like very late at night when there are few places to drive to at that hour, or in the middle of a weekday afternoon, when most people are at work.

Ongoing Claim

    Vehicles:

    ·     Minor collision results in excessive repair costs.

    ·     There appears to be prior damage to the vehicle.

 ·     Impact is relatively minor but repair shop wants to charge to straighten frame.

      ·     Damage does not align between vehicles. (color of paint transfers, height of damage, location of damage, motion of damage, shape of damage, etc.)

·     More than one vehicle involved in the accident goes to the same auto repair shop.

·     The appraiser has a hard time arranging an inspection of the claimant vehicle, or it is already repaired and thus cannot be inspected.

    ·     "Cash" repair invoices are offered as proof of payment for car repairs, rather than cancelled checks or credit cards vouchers.

Statements:

   ·   Claimants do not accurately describe the physics of the accident (Note: the upper body of an automobile occupant will always move toward the point of impact.)

    ·   Claimants cannot provide minor details of the accident, such as descriptions of landmarks at the accident scene, detailed descriptions of the doctor who allegedly treated them, and how their medical examination was conducted, etc., but only provide a basic story with no further details that one might expect them to remember.

·     Claimants are hesitant or overly vague in their responses to basic questions.

·     All claimants treat at the same facility.

·     The diagnosis, symptoms and length of treatment are very similar for all claimants.

·     Injuries are all of a subjective nature, such as soft tissue injuries.

Medical Reports:

·     The RVS or CPT codes used for the initial examination ends in a "4" or "5" for soft tissue injuries only.

    ·     The RVS or CPT codes for interim or final examinations do not change from the initial examination.

·     Medical treatment is extensive, ongoing for more than 2 months or so, on a minimal impact accident.

·     No claim is made for lost earnings despite extensive medical treatment which would have consumed numerous hours during the normal work week.

·     Medical reports are photocopies, or appear to be of the "cookie cutter" variety, where the claimants' names and data are placed into a computer which then spits out a pre-written report.

General:

    ·     Index returns indicate an active claims history.

·     Claimants seem overly familiar with the claims process.

·     Claimants are overly pushy for settlement.

   ·     No towing charges claimed when damage estimates suggest cars could not, be driven from the accident scene.