INDICATORS OF FRAUD


Heritage Publishing, Inc. © 2012


Indicators Associated With the Claims Process • Insured over-documents losses with a receipt for every loss and/or receipts for older items of property


• Insured’s loss inventory differs significantly from police department’s crime report • Insured cannot provide receipts, cancelled checks or other proof of ownership for recently purchased items


• Insured provides numerous receipts for inexpensive items, but no receipts for items of significant value


• Insured provides receipt(s) with incorrect or no sales tax figures • Insured provides receipt(s) with no store logo (blank receipt) • Loss inventory indicates unusually high number of recent purchases • Insured cannot recall place and/or date of purchase for newer items of significant value • Insured indicates distress over prospect of an examination under oath • Insured cannot provide bank or credit card records for recent purchases of significant value • Insured provides receipts/invoices from same supplier that are numbered in sequence • Insured provides receipts from same supplier with sequence numbers in reverse order of purchase date


• Insured provides two different receipts with same handwriting or typeface • Insured provides single receipt with different handwriting or typefaces • Insured provides credit card receipts with incorrect or no approval code


Indicators of Automobile Accident Schemes • Either no police report or an over-the-counter report for an accident resulting in multiple injuries and/or extensive physical damage


• Accident occurred shortly after one or more of the vehicles were purchased or registered, or after the addition of comprehensive and collision coverage to the policy


• Insured has a history of accidents within a short period of time on one policy • Index returns indicate an active claim history • Insured has no record of prior insurance coverage although damaged vehicle was purchased much earlier than inception of policy and date of loss


• Expensive, late model automobile was recently purchased with cash • Attorney’s lien or representation letter is dated the day of the accident or soon after


Indicators of Auto Physical Damage Fraud • Serious accident with expensive physical damage claim but only minor, subjectively diagnosed injuries, with little or no medical treatment


• Despite expensive damage claims, the claimant vehicle remains drivable. Often, there are no towing charges for removing vehicle from the scene of the accident


• Claimant vehicle was struck by a rental vehicle soon after the rental had occurred • Claimant vehicle is not to be repaired locally, but driven or shipped out-of-state for repair • All vehicles in a reported accident are taken to the same body shop • Claimant vehicles are not readily available for independent appraisal • Reported accident occurred on private property near residence of those involved


Indicators of Medical Fraud/Claim Inflation • Three or more occupants in the claimant or “struck vehicle”; all of them report similar injuries


• All injuries are subjectively diagnosed, such as headaches, muscle spasms, traumas and others • Medical claims are extensive, but collision is minor with little physical damage to vehicle


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2012 Jacksonville Claims Association Resource Guide


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