INDICATORS OF FRAUD
Heritage Publishing, Inc. © 2013
• 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 • Offers inducement for quick settlement • Is very knowledgeable of claims process and insurance terminology • Income is not compatible with value of insured vehicle • Claims expensive contents in vehicle at time of theft • Is employed with another insurance company • Wants a friend or relative to pick up settlement check • Is behind in loan payments on vehicle and/or other financial obligations • Avoids meetings with investigators and/or claim adjusters • Cancels scheduled appointments with claim adjusters for statements • Has a previous history of vehicle theft claims
Indicators of Fraud Related to the Vehicle: Vehicle • Was purchased with cash with no bill of sale or proof of ownership • Is a new or late model with no lien holder • Was very recently purchased • Was not seen for an extended period of time prior to reported theft • Was purchased out-of-state • Has a history of mechanical problems • Is customized, classic, and/or antique • Displayed “for sale” signs prior to theft • Was recovered clinically/carefully stripped • Is parked on street although garage is available • Was recovered stripped, but insured wants to retain salvage and repair appears to be impractical • Is recovered by the insured or a friend
100 2013 Jacksonville Claims Association Resource Guide
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