Injury and Insurance Fraud Investigations
Fraudulent injury and insurance claims cost billions of pounds each year, we obtain evidence to support or discredit these claims.
Insurance Claim Validation
The increase in fraudulent insurance claims in the insurance industry has had a dramatic effect on the premiums paid by everyone, in recent years we have seen a significant rise in the number of fraudulent activity and exaggerated claims. Most insurance claims are subject to some form of claim validation ranging from a routine telephone interview with the claimant to an in-depth insurance fraud investigation.
Where injuries are sustained and they have an impact on the claimant’s quality of life, the initial compensation and ongoing financial support can cost an insurer millions of pounds. The claim will be based on a number of factors such as the involvement of the liable party, whether they had followed their legal obligations, the impact this has had on the claimant – both physically and psychologically, loss of earnings, damage to property or possessions and any lasting effects on the claimants quality of life.
If there are precarious grounds for the claim, a lack of evidence or suspicions about the legitimacy of the claimant, insurers are likely to review the claim.
Where the claim value is substantial this frequently warrants the use of insurance investigators and loss adjusters, the role of an insurance fraud investigator is to obtain evidence (Usually covertly) that will either support or discredit the claim. This can be equally important for supporting claims as it can for disputing them, every victim deserves to be compensated fairly for an accident and the evidence provided by a private investigator may reassure the insurer that no further examination or scrutiny is required.
Private investigators often take on the role of a loss adjuster, a loss adjuster’s role is to provide support and guidance in the event of an insurance claim. Whilst a loss adjuster will work for, or be instructed by an insurer, there are impartial industry bodies that set out codes of conduct they must adhere to. In cases of fraudulent claims, the cost of a loss adjuster can significantly reduce the overall financial liability of the insurer.
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Why would private investigators get involved in Injury & Insurance Investigations?
I had a car accident and the other person is lying about their injuries
Injury & Insurance Investigations
In the event of a false injury claim, our most powerful tool is surveillance. In the case of false claims, we would collect all the details you have for the individual and talk about your concerns. This will help our insurance fraud investigators and investigations team identify an address, do background checks, conduct interviews, and gather key information, photographic and video evidence. While the effects of injuries can change over time, with some good days and bad days, if we can gather robust and conclusive evidence of their behaviour over time, showing it to be inconsistent with their alleged injuries, you will be able to make a case that your business insurance should reassess their claim.
An employee sustained an injury at work and is claiming they are unable to return to work
Injury & Insurance Fraud Investigations
In manual handling industries, particularly, firms take great steps to ensure their employees are operating in a safe manner, but injuries do happen. If an employee’s claims are inconsistent with the nature of their injury or with your records of the accident, you may have reasonable cause to investigate. As with insurance fraud investigations, the most conclusive evidence we can provide is video evidence of the employee behaving in a manner inconsistent with their claims. Using employee investigations and covert surveillance techniques, we can ascertain whether or not the employee is really unable to work and provide photographic or video evidence to support this.
A customer had an accident at our business premises
Injury & Insurance Investigations
Health and safety is an ongoing part of the business but unfortunately, accidents do happen and sometimes they lead to injuries, if a customer has been involved in an accident on your premises you may find they make a claim against your business. The role of a private investigator is not to prove the customer is lying but to conduct a non-partisan injury & insurance fraud investigation to gather evidence and verify the facts. Photographic and video surveillance reports can be used by your insurer to defend against a fraudulent insurance claim.
What our customers said
Insurance Fraud Case Studies
Whiplash Claim
Corporate Private Investigation Services
We assist employers, who might otherwise avoid investigating dishonest staff because they lack experience or fear legal action.
Exaggerating injuries for financial gain creates stigma and undue stress for those who rely on compensation and injury payments.
Becoming a victim of fraud can be stressful and financially devastating so investigating it professionally and effectively is vital.
Process servers provide a trusted method of delivery that ensures documents have been received by the respondent.
Mystery shoppers collect vital intelligence about the customer’s experience and can find evidence of unscrupulous retailers.
Enquiry agents can conduct covert and overt enquiries, obtaining additional information to support investigations.
Insurance for fraud investigation: FAQs
Yes, you must have reasonable grounds to investigate claims validation, and the insurance fraud investigation itself must be proportionate to the claim and the accusation.
If you are instructing us from a Public Body such as a local authority you may need to obtain judicial approval to adhere to the Regulation of Investigatory Powers Act (RIPA) and we are happy to advise on the application should it be required. This does not apply to individuals and corporate clients.
The first step is to establish whether you have cover to protect yourself against the claim, once you have done that you should try to gather as much information about the incident as possible and identify who is liable for the claim.
If you feel the claimant or the incident is suspicious then contact an insurance fraud investigator to discuss potential fraud and the possibility of launching an investigation.
Yes, all of the injury & insurance investigations we conduct are done so legally, lawfully and ethically.
The information we obtain will be prepared to a standard that is suitable to be admissible as evidence.
FAQ
If somebody commits fraud or makes a fraudulent claim against you or your business we can counter fraud and obtain evidence to establish whether their behaviour is consistent with their claim.
This is particularly important in cases where you may be liable for damages or injuries that are being exaggerated or falsified.
We always aim to provide indisputable evidence however this is not always possible. In the event that the information we provide is questioned or scrutinised, we will attend court to support our evidence as required.
There is no set timeframe for an insurance investigation as it will depend on a number of factors, the severity of the issue, the awareness of the subject, the size of the claim and the evidential requirements.
On average we see insurance fraud investigations (e.g. healthcare fraud, disaster fraud) last for between 1-3 weeks at a time but they are frequently revisited months and sometimes years down the line to establish whether the situation has changed.
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