Investigating Fraudulent Personal Injury Claims

Filing a fraudulent personal injury-related insurance claim can have serious ramifications. Not only can the insurer deny your claim, but you could also be liable for any money paid to you and for the cost of the investigation of the claim. You could even face criminal charges. Insurance companies often contact Bearden Investigative Agency to investigate when fraud is suspected. We uncover the facts with extensive documentation.

What is a Fraud in a Personal Injury Insurance Claim?

Personal injury-related insurance fraud is typically defined as any act intended to cause an insurance company to compensate you for an injury that is nonexistent, exaggerated, or unrelated to any accident covered by the policy. Common examples include faking or exaggerating the nature and extent of injuries after an accident, or planning or staging a theft, arson, or car accident.

Types of Fraudulent Personal Injury Claims

There are two basic types of fraudulent personal injury-related insurance claims: “soft” insurance fraud and “hard” insurance fraud.

Soft Insurance Fraud is also called “opportunistic” insurance fraud and it is the most common type of insurance fraud. Soft insurance fraud involves exaggerating the severity of your injuries and filing inflated claims. Obviously, an injured individual will need to get every dollar their injury justifies, but when they claim losses beyond actual damages, they cross the line into fraud.

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

Private Investigators Find and Document Fraud

It is not uncommon for an insurance company to contact our agency to investigate suspected fraud. Because our agents are attorney-led, they are well versed in the legal ramifications of insurance fraud and therefore can more easily identify and document in a manner that is admissible in court.

Woman faking injury goes skiing and posts to social media

Woman faking injury goes skiing and posts to social media

Many times, the trigger that sets off alarms for insurance companies is a simple social media post that contradicts claims of injury. Our investigators conduct social media investigations by scrubbing profiles for any documentation proving fraud. Social media activity is documented in detail. Every tweet, like, share, swipe and comment are there for our review. We have seen it all, and this type of initial investigation typically provides an eye-opening wealth of information that we then provide to the insurance companies.

In some cases, our agents conduct surveillance of a suspected fraudulent claimant. During surveillance we are investigating their actions, activities, and movements to accurately document the visible extent of injuries. For example, an injured party claimed to have suffered significant injuries that required the use of a wheelchair. While conducting surveillance, our agents were able to document the claimant moving about freely without the aid of a wheelchair, walker or crutches which helped the insurance company avoid paying out the massive fraudulent claim.

So, if you are making a personal injury claim, be sure to play by the rules. Always avoid exaggerating injuries, and steer clear of any hints of fraud. You never know if a private investigator is around the corner waiting to document your deception!