How can insurance fraud be Investigated?


What is Insurance Fraud?

Frauds are unavoidable and can happen to anyone at any place. Cases of insurance fraud are typical these days. There are a number of frauds related to insurance happening in today’s time that we hear about. People obtain a lot of financial benefits by doing fraud. Both the insurer and the insured are liable for committing insurance fraud.  

Insurance fraud is an illegal act committed by the buyer or seller of the insurance to get financial benefits out of it. Insurance frauds lead to suffering huge financial losses. It includes selling fake policies from non-existent companies, failing to submit premiums, exaggerated claims, faking death, and murder to get the benefits of insurance. People also create photoshopped receipts images or videos while executing such frauds. Companies should hire legal teams to keep a check on such frauds. One should gather enough evidence to file a case against the fraud.

Types of frauds?

There are diverse cases of insurance fraud but the most common ones are the fraud related to vehicle insurance and healthcare insurance. These are also known as hard frauds and such cases need court procedures. People make false insurance claims to deceive the insurance provider.

Vehicle insurance Fraud:  Here, a person might intentionally dispose of the vehicle, sell it or abandon the vehicle and yet portray that the vehicle is stolen or damaged. This is done to claim insurance benefits such as money or replacement of the vehicle.

Healthcare Insurance fraud: In this type of fraud, people misrepresent information like fraudulent bills, false receipts or photoshopped images, or claims on behalf of ineligible people to enjoy benefits. In order to get reimbursement, falsifying details are shown to get the benefits of insurance claims. There are numerous cases like these.

Some of the schemes related to insurance fraud are Premium diversion, Fee churning, and Asset diversion.

Another type of insurance fraud occurs when anyone portrays a loss, theft, or fire to get the benefits of the insurance policies. This way people show fake evidence of miss happening to get the benefits of insurance. 

Some of the methods to handle such frauds related to insurance are:

  • Getting history of claims and accidents – getting proper history about the claimant or the accident, any theft is mandatory. 
  • Proper Surveillance of the claims – proper surveillance can help to dig into the details of the claims made by a person is true or not.
  • Analysis of coverage claims – a detailed analysis of the evidence and proofs provided by the claimant is crucial before providing the benefits of the insurance. 
  • Talking to witnesses – one can get clarity on the suspect by talking to witnesses.
  • Verification of medical reports – verification of documents and medical proofs provided by the insured needs to be checked. 
  • Checking billings of physicians or doctors – false bills need to be checked before the claimant gets the insurance claimed.
  • Background checks of the claimant – proper background checks are important so that the insurance process is smooth and risk-free.

The main aim of Insurance fraud is generally greed and to enjoy the financial profit by false claims. It leads to the exploitation of insurance policies. These frauds happen due to the selfish motives of fraudsters. Therefore, Insurance fraud Investigations must be carried out if there is a suspect of wrong claims by a person. Looking for a Detective Agency in Mumbai can be fruitful to gather small details, do proper verifications, surveillance, talking to witnesses, etc. on such matters. Also, insurance companies are getting more cautious while paying insurance claims to avoid becoming victims of such frauds.


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