How Car Accident Claims Adjusters Investigate Fraud

Car insurance fraud costs insurance companies billions of dollars every year. This amount is then passed onto the public, which has to pay higher premiums.

Car insurance fraud costs insurance companies billions of dollars every year. This amount is then passed onto the public, which has to pay higher premiums. As a consequence, automobile insurance companies take fraudulent insurance claims very seriously. This article will discuss how a car accident claims adjuster investigates fraud.

What is a Fraudulent Personal Injury Claim?

Car accident fraud is typically defined as any act or omission that is intended to cause an insurance company to compensate you for an injury that is either nonexistent, exaggerated, or unrelated to any accident covered by the policy. Common examples include faking or exaggerating injuries from an accident, or planning or staging a car theft, arson, or collision.

It is important to note that you can be guilty of fraudulently filing a car accident claim even if you do not lie or make false representations; if you simply fail to disclose information which you have a legal duty to disclose, or which would be reasonable for you to disclose under the circumstances, you may be guilty of filing a fraudulent personal injury claim.

Types Of Fraudulent Personal Injury Claims

There are two basic types of fraudulent car accident claims: (1) soft insurance fraud and (2) hard insurance fraud.

  • Soft Insurance Fraud. Soft insurance fraud (also called “opportunistic” insurance fraud) is the most common type of insurance fraud. Soft insurance fraud occurs when the claimant makes an inflated claim, such as exaggerating the severity of a car accident neck injury.
  • Hard Insurance Fraud. Hard insurance fraud (also called “premeditated” insurance fraud) occurs when the claimant devises a way to make an insurance claim. This type of insurance fraud usually involves some sort of deliberate action, such as intentionally causing an accident or staging arson or theft of the vehicle.

How a Car Accident Claims Adjuster Investigates Fraud

An insurance adjuster investigates fraud in a variety of ways. The most common ways include:

  • Police reports. Insurance adjusters will analyze the reports prepared by the police officer at the scene to determine whether there is anything suspicious contained in the report, including inconsistencies.
  • Statements made by parties and witnesses. Insurance adjusters will ask to interview you and take a record of your statement. They will compare this statement against the statements made by all the parties involved, as well as those of witnesses (if any).
  • Doctor’s reports. Insurance adjusters will analyze the doctor’s reports that accompany your claim to see if your injuries are supported by medical evidence.
  • Social media. Social media sites have become the go-to place to go for insurance adjusters. Oftentimes, people will boast about the crimes they have committed on their Facebook or Twitter pages, or post pictures showing themselves participating in physical activities that contradict their claims of suffering from a serious and debilitating injury.
  • Research on databases. After all the information about your accident is gathered, insurance adjusters will check that information against databases shared with other insurance companies. All insurance companies share information about the frequency of accidents reported by individuals. The adjuster will compare your claims against all the claims submitted in the past. The adjusters have been trained to identify and recognize factors that have been associated with false insurance claims and will compare your claim against other claims in order to discover a discrepancy. Insurance companies also keep a database of all recent claims made by every individual. If the database shows that a certain individual has filed a high volume of claims, the adjuster’s investigation will be more detailed.
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