Heritage Publishing, Inc. © 2012
INDICATORS OF FRAUD
• All of the claimants submit medical bills from the same doctor or medical facility • Medical bills submitted are photocopies of originals • Summary medical bills are submitted without dates and descriptions of office visits and treatments, or treatment extends for a lengthy period without any interim bills
• Vehicle driven by claimant is an old “clunker” with minimal coverage • Insured, even though legally liable for accident, is adamant that claimants were responsible for accident, indicating that the insured may have been “targeted” by the claimants
• Claimants retain legal representation immediately after accident is reported • Minor accident produces major medical costs, lost wages and unusually expensive demands for pain and suffering
• Past experience demonstrates that the physician’s bill and report, regardless of the varying accident circumstances, is always the same
• Treatment prescribed for the various injuries resulting from differing accidents is always the same in terms of duration and type of therapy
• Medical bills indicate routine treatment being provided on Sundays and holidays
Indicators of Lost Earnings Fraud • Employment information is for an unknown business, often with a post office box for address, or a street address in a residential area
• Business telephone number is connected to an answering machine or answering service • Lost earnings statement is handwritten or typed on blank paper, not business letterhead • Claimant started employment shortly before accident occurred, or is self-employed • One or more elements of claim is questionable, e.g. length of absence, rate of pay, income incompatible with claimant’s residence
• Efforts to verify lost wage statement with employer raise doubts about employer’s legitimacy or about the actual employment of claimant
Slip & Fall and Food/Products Liability • Presence of an overly enthusiastic witness at the scene of the incident • No supporting evidence of foreign or contaminated substance; claimant threw food out and has only the can, box or wrapper
Indicators of Fraud Concerning the Insured: Insured • Has lived at current address less than six months • Has been with current employer less than six months • Address is a post office box or mail drop • Does not have a telephone or listed number is a mobile/cellular phone • Frequently changes address and/or phone number • Place of contact is hotel, tavern • Handles all business in person, thus avoiding the use of mail • Is unemployed • Claims to be self-employed but is vague about the business • Has recent or current marital and/or financial problems • Has a temporary, recently issued or out-of-state driver’s license • Driver’s license has recently been suspended • Recently called to confirm and/or increase coverage • Has an accumulation of parking tickets on vehicle • Is unusually aggressive and pressures for quick settlement
2012 Jacksonville Claims Association Resource Guide
113
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