What are the False Claims Your Insurance Company Can Spot?

By USInsurance.com Staff

Insurance fraud and false claims are a big business in the U.S – involving shady doctors and lawyers to employees at auto body shops to workers claiming false injury reports. According to the National Insurance Crime Bureau (NICB), “studies indicate that 10 percent or more of property/casualty insurance claims are fraudulent.” Over time, this will raise premiums and can cost the average family an additional $400 to $700 a year.

Insurance companies can spot false clams and scams and according to NICB the following insurance claims will always get a red flag:

Theft: Insurance companies receive many claims for home and auto theft. However, there are some situations that are obviously false. If a claimant increased their homeowner’s insurance or home office insurance policy shortly before an incident or damage to the property occurs. Also, if a claimant has high-debt, provides hand-written receipts or claims a loss of goods to old family heirlooms whose value is difficult to establish are seen as a red flags to insurance companies.

Fire: Fire is another unfortunate event, however it is estimated that approximately 300,000 fires occur intentionally, according to the National Fire Protection Association. A claim will be investigated if a fire spreads unnaturally and caused damage only to specific pieces of property or if sentimental items were not damaged in the fire or seem to have been removed. An investigation into the fire may also be followed if a fire was caused following a domestic fight, if entrances were blocked prohibiting firefighters from entering a home of if the whereabouts of the homeowner or renter during the fire are questionable.

False Doctor Claims: Sometimes doctors are involved in false claims. If a doctor recommends expensive treatment options or bills insurance companies for procedures that were never performed on a patient, the insurance company will likely look at this as a red flag. For example: if an individual had an auto accident and need stitches, but the doctor billed an insurance company for a surgical procedure.

False Workers: Injuries on the job are bound to happen, especially with labor-related jobs. When an employee is injured to the point of no longer being able to perform their work-related duties they will receive disability, workers’ compensation or personal injury insurance. However, there are some incidents that insurance companies may consider red flags such as if an employee states that they slipped and hurt themselves; but there were no witnesses. An employee who reports on a claim late, a doctor’s diagnosis does not match what the employee claims or a claimant who refuses treatment offered by a doctor. Also, an employee who may have been laid off or was having problems with a supervisor may spark the attention of an insurance company.

Other False Claim Indicators: Insurance companies are also wary if a claimant files multiple claims, especially if they are very quick with their reports. Like, say for a slip or if there was theft and they automatically file a claim. Additional indicators of potential false claims: a clamant is very calm after a catastrophic event such as a home fire or burglary, no police report was filed or there is a history of claims.

Bottom line: Don’t cheat your insurance company. If you suspect someone of falsifying a claim, contact NICB at (800) TEL-NICB (800 835-6422).


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