What does an insurance fraud investigator do?

An insurance fraud investigator may use surveillance to determine the validity of a claim.

An insurance fraud investigator is an individual who works for an insurer to determine whether a claim was made under false pretenses. This is especially true in the case of disability claims, where individuals may say that their movement or quality of life is limited because of chronic pain. Due to the fact that chronic pain is often difficult to clinically prove, this can pose a problem for insurers. Some may also investigate medical bills, but they are easier to verify.

An insurance fraud investigator may be required to testify in court.

In some cases, a fraud investigator will work for an insurer full-time. Larger companies often have enough cases where they can support an individual, or even an entire department, in this capacity. The other alternative, of course, is to use the services of a private investigator, hiring the services only when necessary. This is how many private practice investigators make a living.

An insurance fraud investigator can investigate disability claims.

After an insurance fraud investigator gets a case, they usually start to gather some basic information. The case file will include the subject’s last known address and any other available personal contact information. The submitted complaint will also be available for the investigator to determine whether the complaint is well founded. For example, in a disability case, the person involved may claim that they cannot use their legs.

An insurance fraud investigator is hired when a false claim is suspected.

After the initial review of the case file, the investigator will usually move on to surveillance work to see if the claim is valid. While this may involve some highly technical equipment such as remote surveillance video, most of the work is done using a standard still camera and video camera. Using the example of the man who claimed he could no longer use his legs, the investigator will look for evidence that this is not true. If he sees the man regularly using a wheelchair, he can conclude that the claim is valid. If, however, he sees the man playing football with the neighborhood children, he will likely document the event with photos and videos and report on his findings.

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People involved in insurance fraud can face criminal charges.

In most cases, the results will be presented to an insurance attorney or consumer fraud attorney. At that point, the company will likely suspend all disability payments to the individual. Civil and even criminal charges can arise as a result of the investigator’s work. At a trial, he may be called upon to testify about what he actually witnessed during the insurance investigation and to report on the accuracy of his equipment and recordings.

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