Insurance Fraud Investigations

Insurance Fraud Investigations: Unravel Insurance Fraud

Insurance fraud investigations by CRI® cover the full range of cases, from healthcare fraud to disability and even fake death claims. Our experts are trained to look for the tell-tale signs of fraud: they can view claims, and medical and hospital records, conduct interviews, examine statements and documents, as well as perform on-site inspections. Insurance fraud is something that no company can afford.

We will work with you and all appropriate insurance personnel or an insurance fraud investigator to achieve the results you need in a timely, discreet manner through private investigation services. CRI® agents bring their investigative training to careful use in every engagement, protecting your confidentiality while uncovering the facts of the case.

SCOPE OF WORK

CRI® handles several forms of investigations, including, but not limited to:

Factual Claims Investigations
Witness Statements
Workers Compensation
Background Investigations
Disability Claims
Asset Searches
Motor Vehicle
Injury Claims
Liability Claims
Medical Audits and Clinic Investigations
Medical Fraud Investigations
Property Claims
Death Verifications
Travel Claims
SIU Services
Fraud Investigations Activity Checks

HOW DO WE CONDUCT AN INSURANCE FRAUD INVESTIGATIONS?

CRI® Group’s insurance fraud investigations are based on a thorough approach that includes site visits and leaving no stone unturned. This is how the process will typically proceed:

Assign the appropriate investigators with the right expertise in that area to investigate the claim.
Contact the parties involved to gather all relevant details about the incident.
Use all resources available, including police reports, court filings, database records and other means to establish the truth in insurance fraud cases.
Make site visits, speak to witnesses, take photos and establish timelines as needed to create a full, truthful story of the incident.
Uncover useful evidence, carefully documenting and preserving it in a way that is admissible in court.
Present investigation findings to the client, with recommendations on how to proceed.
Sometimes, legal action is warranted.

WHY PARTNER WITH US?

Working with an insurance fraud investigation company like CRI® provides the advantage of having an independent, impartial and unbiased third-party collecting the facts you need regarding any case that might involve potential fraud.
CRI® has been safeguarding businesses for more than 30 years, and you will be assured of the quality, professionalism and discreet nature of all investigations conducted by our experts.
Our global presence ensures that no matter how international your operations are, CRI® Group’s investigations have the network needed to provide you with all necessary support, wherever you happen to be. We take great care to ensure that our trained and licensed investigators are the best at what they do.

ABOUT INSURANCE FRAUD

Every type of insurance is vulnerable to insurance fraud. Insurance fraud cases are often committed by opportunists – such as claim fraud, where perpetrators invent or exaggerate a claim; or application fraud, where they deliberately or recklessly provide false information when applying for insurance. There are well-known cases of highly organised criminal gangs with money-making enterprises based on insurance fraud.

Insurance fraud cases cover a wide range of schemes and crimes, intended to enrich the fraudsters at the expense of insurance providers and other innocent victims. With the enormous liability presented by insurance fraud, every organisation should address the risk in their due diligence and fraud prevention programs.

TYPE OF INSURANCE FRAUD

The 10 most common types of insurance fraud include:

Car damage
Staged home fires
Health insurance billing fraud
Storm fraud
Faked death
Abandoned house fire
Car accident
Renter’s insurance
Unnecessary medical procedures
Stolen car

IDENTIFYING RED FLAGS

The 7 red flags of fire loss insurance claim. If your answer is yes to any of these red flags, then you may have a case of insurance fraud in your hands:

Does the claim include expensive property, often newly purchased without documentation, allegedly destroyed along with the home?
Is sentimental property suspiciously not listed among the missing/destroyed property?
The claimant cannot provide detailed descriptions of the destroyed property or where it was purchased?
Does the documentation provided by the claimant look altered or irregular?
What the claimant claims in property loss does not match the physical site?
The claimant refuses to answer questions, or gives confused or inconsistent answers?
The claimant fails to provide additional documentation when asked, even if he promises to do so?

The 4 red flags of hospital billing insurance claims. If your answer is yes to any of these red flags, then you may have a case of insurance fraud on your hands:

Do the bills appear irregular, or documentation is incomplete?
There is a history of claims by the subject for different, seemingly unrelated health procedures or
treatments?
Dates and locations for hospital visits seem unlikely or cannot be corroborated with verified records?
The claimant avoids answering questions about the claim or gives confusing or inconsistent answers?

Brochure & Publication on Insurance Fraud Investigations:

Brochure: Investigative Solution

Investigations solutions covering insurance fraud cases, from healthcare fraud to disability and even fake death claims.

Download Brochure

Case Study: Insurance Fraud Cases Uncovered

This ebook is the perfect primer for any insurance fraud professional and companies looking to avoid becoming victims of insurance fraud claims.

Download e-Book

Request an Insurance Fraud Investigations Quote

Please complete the form below to help us prepare the best and most accurate quote for you. We will get back to you within 48 working hours.

YOUR INSURANCE FRAUD INVESTIGATIONS EXPERTS

Zafar I. Anjum

Group CEO

Kanwal Zafar

Managing director

Anab Gul

Head of Investigations

Ashelea Arzadon

Senior Investigations Manager

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