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  • Writer's pictureDan Fleming

Liability Investigations

Medical evidence is very subjective for liability claims involving injury. Staged accident rings can become complex and hard to investigate. What is consistent in fraud is the intent from the claimant | motive | justification | opportunity (the claim), and the reward (money). This is commonly referred to as the "Fraud Triangle", and a knowledge of these three points is required to prove insurance fraud, and mitigate risk.

How to identify fraud in this line

  • Industry information exchange databases.

  • Obtain private auto dash cam footage | useful in logistics and transport injuries etc.

  • OSINT | social media | deep and dark web.

  • Detailed recorded statements from all parties.

  • Obtain all original documentation to rule out altered documents.

  • Detailed interviews with all parties for clear understanding of the whole event.

What to look out for

  • Vague facts of loss | incident resulting in claim.

  • Claims that fail | the reasonable person test.

  • Incidents that occur out of technology range | reception | CCTV view etc.

  • Inconsistencies between claim and police data.

  • No police involvement even though injuries | damages reported to insurance carrier.

Trends and insights

  • Fraud can occur in many forms in liability claims from first to third party, don't narrow your focus to one potential scheme.

  • Smaller police jurisdictions are often interested in assisting with insurance fraud.

  • Stay on top of the ever-changing social media trends to aid you in your claim investigations.

  • Mobile Phone records are a great way to confirm timelines surrounding the loss and potentially connect parties who claim to be unrelated.

Insurance fraud is here to stay. The way in which it is carried out may vary, but the pillars of the | Fraud Triangle will always remain. Criminals will capitalize on environments where holes are created, or new automated and online processes appear.


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