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INDICATORS OF FRAUD


• 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 • 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 2013 Jacksonville Claims Association Resource Guide 99


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