Insurance fraud is a crime and is a big problem in Australia. Because insurance fraud is costly, prosecutors take insurance fraud seriously and actively investigate and prosecute those suspected of insurance fraud.
What is insurance fraud?
Insurance fraud is a crime committed against an insurance company by an insured person who knowingly lies to the insurance company in order to obtain a payment that they are not legally entitled to. If the insurance claim officer suspects that the insurance claim is fraudulent, the claim is assigned to the Fraud Department for further investigation, after which the case is forwarded to the criminal or local prosecutor’s office. All types of false, fraudulent and untrue insurance claims, including car theft and accidents, health insurance, and homeowner fraud, are subject to criminal prosecution. If the prosecutor can prove that the suspect had the intention to defraud and commit this type of crime, then the actual loss of the insurance company is not necessary. As a result, they are charged with a misdemeanor or felony and, if found guilty, face heavy fines, reparations, and imprisonment in a county or state prison.
What is the appearance of insurance fraud?
The following are some of the typical insurance fraud cases.
Receive treatment for false injuries and submit a claim to the insurance company.
Lying on the insurance claim on purpose.
To arrange a traffic accident or fabricate an injury that has not occurred, in order to receive money from the insurance company.
Reporting stolen vehicles and making false insurance claims.
To claim false traffic accident insurance and false property loss insurance.
Start a fire to collect money from insurance companies (also known as for-profit arson).
To receive unemployment benefits from the state unemployment insurance fund while still working.
To fake your own death in order to receive insurance.
To make false worker compensation claims.
To charge for excessive medical expenses, such as chiropractors and medical clinics.
Submit a false invoice to Home Owner’s Insurance.
Filing a false life insurance bill.
Claim insurance money on behalf of others. This is a common health insurance scam that attempts to obtain the identity of someone else and claim the insurance of the person who stole it.
Claim for damage to non-existent household goods.
Submit an untruthful police report as part of an insurance claim.
Misrepresent the information in the insurance application form.
Exaggerate the value of the goods taken in the event of robbery or theft.
Make a false injury claim even though no damage has occurred (e.g. slipped and fell).
Inflate damage repair estimates (typically by auto repair and home repair specialists) to improve the car, not just repair.
After the accident, she/he received the following insurance. A driver has a car accident and is not insured. This person immediately takes insurance, waits a few days, then reports the accident and receives money from the insurance company.
Why is insurance fraud a problem for everyone?
The conclusion is simple and clear, and fraud harms us all. With the increase in fraud, insurers are increasing expenses in two ways: increasing compensation payments and investing heavily in fraud discovery research. Both costs have a direct impact on the increase in premiums for all insured people, regardless of how sincere they are.
Because of the losses caused by such crimes, insurance companies have been forced to develop advanced fraud detection systems, set up specific departments to mitigate the impact, and even hire private detectives to assist with investigations.
There are 5 points to detect insurance fraud.
Fraud in the insurance industry can take many forms. It can range from digital, such as edited photos, to physical, such as abuse of insurance claims procedures. It can also be opportunistic, or deliberately organized, and can arise from a variety of sources, including internal employees, external individuals, criminal organizations, and networks.
Application of data.
Aside from the financial impact on insurers’ earnings, we expect insurers to manage premiums as carefully as possible, including detecting and preventing fraud. This is possible only with a large amount of data and advanced analytical capabilities.
Anti-fraud using Network Analytics.
To identify a criminal network or organization, network analysis in the form of a knowledge graph is often required. Third-party data from location, social media, obituaries, repair costs, and more can be used to quickly identify suspicious claims and applications.
Leverage new technologies.
New data analytics technologies enable cloud computing and streaming data, integrating structured, unstructured, and third-party data to prevent, detect, and ultimately eliminate fraud altogether.
There is no resistance to change.
With the advent of the pandemic, digital transformation has accelerated. The traditional method no longer works. Some organizations use drones and satellite imagery to combat crime. The use of the internet is also important to implement geolocation.
In terms of fraud prevention, the cloud is reassuring.
With processes and models based on real-time analytics, cloud technology can store, mix, and scale data faster than ever. Even terabytes of data can be processed up to 50% faster thanks to the cloud, which is essential for fraud detection.
What is insurance fraud investigation?
An insurance fraud investigation is a process designed to determine whether you are making fraudulent claims for insurance. Experts from insurance companies and private detective firms will conduct the investigations. As with law enforcement investigations, the purpose is to reveal what has happened, whether it is lawful and to whom it is responsible.
Insurance fraud is a global problem and is said to cost billions of dollars a year. Misconduct not only damages the insurance company, but also damages everyone who is insured because insurance premiums are recalculated and adjusted based on these costs.
Insurance company representatives and experts consider the case under review to be suspicious, missing important information, or apparently fraudulent, and initiate an investigation.
When conducting an accident analysis, we collect information that we believe is accurate, check the scene of the accident, listen to interventionists and witnesses, consult with experts and databases, and seek assistance through legal means through insurance companies if necessary.
Some insurance fraud investigations explore procedures and claims that are suspected to be false. For example, if a doctor and a patient conspire to make it appear that they were subjected to an improbable medical examination for an improbable injury, this is insurance fraud, and an organized investigation can reveal the details of what has occurred.
Insurance Fraud Investigation in Australia
Auscovert Investigations investigates a wide range of cases of insurance fraud, from medical fraud to disability and even fake death claims. Our experts are trained to look for signs of fraud, review insurance claims, medical and hospital records, conduct interviews, investigate statements and documents, and conduct field investigations. No company is allowed to become a victim of insurance fraud.
Insurance fraud is a serious crime with serious consequences for the perpetrator. Perpetrators can be impeded by future work, find it difficult to access insurance and other important financial services, be criminally convicted, or imprisoned.
We will work with you and all relevant insurance stakeholders to achieve the results you need, timely and individually. Auscovert Investigations agents provide investigative training to help you keep your secrets and uncover the facts of your case.