Working as the claim settlement manager for an insurance firm, I have been dealing with a variety of claim cases coming for a compensation of various types of losses, thefts and damages occurs to the insured properties. At time, I am handling motor accidents, workers compensations, TPA, medi-claims and high profile death claims.
During this tenure, I could feel that more that 60 % of cases are fake composition, where people are fixing false or bogus documents to make a claim. Such documents don’t justify the validity of the matter and put us under doubt about the genuineness of claims. In such cases, we have to get them verified by using our own field staffs.
But, our verification officers are having certain limits to verify a document. They are not able to properly handle the matter.
That why, majority of sensitive cases remains beyond their ability to get them checked? Therefore, I have to deal with all the serious cases by using the suitable process of Insurance frauds claim investigation to reach to the fact.
These are genuinely some of the most sensitive cases, where a verifier has to be on toes to visit concerned sites to find the fact and verify all evidences. It is also needed to get the recorded statement of the involved persons.
One fine day, I happen to get a similar case. It was the case of personal injury claim. Here, an insured person met with an accident, while driving his car. His claim papers came to us compensation, where it was stated that he had a fracture in his right leg. The person is still taking the treatment in a hospital. The supporting documents like diagnosis, tests and prescription were so bulky remarks, as if the person is taking heavy treatment for a complex disease.
It created several doubt and I decided to find the truth, so I sent our field officers to that hospital to see the patient and confirm the matter. When our officers reached there and asked the staff to see the patient for knowing his condition, they were halted at the doorstep by the staff by saying that they won’t allow anybody other than attendant, to see the patient as frequent visitor may disturb him. Moreover, the patient is not yet well to give much reply.
When our officers urged them to take his photo, then they permitted our officers to get a snap by maintaining a distance.
Our officers returned without getting much information, so, it was not a worthy visit. Now I thought of using Insurance frauds claim investigation services to reach to the fact. Because I heard that such sources can turn all impossible things into a possibility. It really worked, as they worked upon the matter and formed best strategy to reach to the fact.
They knew that they can’t reach to the patient by using the simple and straight actions. They used effective tricks to him. Through this way, they could find the total facts about the matter, as it was a minor injury, and there was nothing much serious. It was basically an urge to get the compensation for the injury and hospital staff was also having a share in that, so only, the staff was showing different behavior to outsiders.
Lastly, the full fact came before us and his claim was turned down. Moreover his policy was terminated permanently without paying his premium back.
With this case, you can know, how people are creating frauds in a claim, if we don’t verify them then we may run under big loss. Therefore, it is always needed by us to verify all claims come to us. I will also advise other insurance firms to make a habit of using such investigations to monitor all claims to secure your revenues.
