Homeowner's Academy

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Protection And Fraud: What Do Bad Claims Look Like

by BROOKE GOLD HASSON | Jul 25, 2014

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How Insurance Agents Notice Fraud

Insurance fraud is a significant problem in the U.S. and it’s often committed by organized groups of people looking to make a lot of money off of many smaller claims. However, individual fraudsters are common too, with small scams where they stage accidents or claim to have an expensive piece of jewelry lost or stolen.

As part of our longer look at fraud and what it means for homeowner’s policy holders, People’s Trust would like to share some ways that agents and law enforcement find fraudulent claims.

Spotting Fraud

In Florida, fraud is a serious crime and can come with significant fines or even jail time. We want to discourage any fraudulent claims by you or people you may know because they ultimately end up costing everyone.

Some of the ways fraud is detected include:

Checking Claims History

Insurers and police often review new claims just to see if someone has made a lot of claims in the past. Previous claims in large groups or around the same type of losses can raise red flags, especially in the realm of auto and home insurance. Checking your claim history doesn’t determine fraud, but it does start a process of investigation where fraud can be detected.

This can also include checking your claim against similar ones made by others. If it matches a pattern of fraud or looks very different, agents may look further into your claim.

Personal Injury Mills

Some fraudsters think being thorough will protect them against scrutiny, but it can make some fraud more obvious. A common practice is using a personal injury mill, especially in slip-and-fall lawsuits.

These folks will say they’ve fallen on your property and then file a claim with chiropractor and other medical paperwork. However, the doctors they claim to visit sometimes don’t actually see the patient or even exist, while others provide false paperwork for a part of the settlement.

These fraudsters also will create businesses of setting fires or floods in homes. This type of activity is often monitored by the police and police work often leads to arrests and jail time.

Data Analysis

To help them better understand claims in general, insurers often use very complex computer systems and data analysis. This shows us patterns and common traits so we can adjust processes to make filing a claim and getting your home repaired simpler and faster. Data is how we improve our products and give you better service.

Data also gives us something to check your claim against. If bills, losses, claims or other information doesn’t look right, insurers will often send someone out to check on the home. Computer systems are great at finding patterns or looking for inflated claims.

This can sometimes be as simple as an automatic check of the weather and forecast when someone claims their home was damaged by a storm.

Social Media Checkups

You never know what some people will put on social media.

Law enforcement has developed a tactic called “social media listening” where they scan social networks to look for clues around claims that may be fraudulent. These claims include a case of a fire consuming a vacant mobile home in New Jersey.

After suspicions were raised, police found a Facebook video showing two people setting a mattress on fire, which in turn caused the whole mobile home to burn down.

People’s Trust wanted to share this information with you to let you know we actively review claims to weed out fraud so we can continue to bring you low-cost, high-quality homeowner’s coverage in Florida.  Let us know what you think should be done about fraud and feel free to ask us any questions below.