Spotting Fraudulent Injury Claims

Fraudulent Injury Claims

During the course of 2019, insurance companies detected 107,000 fraudulent claims, amounting to £1.2 billion[1]. Within this statistic are false injury claims, buried within motor insurance claims and liability claims – otherwise known as ‘slip and trips’. Those perpetrating these claims may well do so in the belief that insurance fraud is somehow a ‘victimless crime’ – that insurance companies are wealthy corporations and that fleecing them of cash doesn’t really cause a problem for people, or society.

In reality, insurance fraud causes people and society significant problems. First and foremost, it causes insurance companies to increase insurance premiums across the board – making policies more expensive for everybody. This can be a particular issue for small businesses or drivers who are young or from low income households. Fraudulent injury claims against small businesses can also cause long-term damage to the commercial prospects of that enterprise, putting the livelihoods of other people at risk. Those fraudulent claims that involve incidents instigated by the claimant for the specific purpose of making a claim, such as ‘crash for cash’ incidents, also pose a significant danger to other members of the public. They can potentially cause genuine injury to people unassociated with the claimant – simply so that the claimant can take money from an insurer.

What do we mean by ‘fraudulent injury claims’?

A fraudulent insurance claim is one that is false. It may be that the claimant has concocted the entire story, has staged the damage, or has experienced an incident that warrants a claim but is exaggerating the impact to increase compensation. In the case of fraudulent injury claims, the potential compensation is generally based upon the severity of the injury, so the dishonesty in these instances is based around the way the injury is presented by the claimant.

For example, another driver may have allowed their car to gently and unexpectedly roll into another, resulting in barely detectable contact. The driver of the hit vehicle may seize the opportunity to claim a serious whiplash injury caused by the incident, exaggerating neck and back pain, and making a claim against the insurance of the other driver. While the other driver is indeed at fault for not being in full control of their vehicle, the whiplash is false, and the claim is fraudulent. Insurance fraud is, quite rightly, a serious crime and can result in punishments ranging from financial penalties to prison sentences, depending on the nature of the fraud.

The prevalence of fraudulent insurance claims means that insurance companies have become highly adept at spotting the signs of attempts at fraud. The processes and procedures deployed by insurance assessors on an incident-by-incident basis help to mitigate the risk of a fraudulent claim being successful but, in the case of personal injury, this can prove quite difficult. Many of the most commonly claimed injuries – whiplash, tinnitus, and back pain, for example – are largely ‘invisible,’ and do not present with surface wounds. In these cases, insurance companies may employ the services of a reputable and professional private investigator to verify the information provided by the claimant.

There are a number of signs investigators may use to determine whether a personal injury claim is fraudulent.

Evidence

If the evidence provided by the claimant is in any way problematic, then this can be a sign that the claim is fraudulent. This might include:

  • Vagueness – A lack of detail can suggest an ill-thought-out, spontaneous case of insurance fraud, or an inexperienced fraudster. This is because, unless the injury caused is so severe that it impacts memory function, most people find incidents of injury to be traumatic experiences and are naturally inclined to remember detail as a result – particularly in those cases where another person or business is at fault, and is to blame for causing the injury.
  • Inconsistency – When evidence is inconsistent, this suggests that it is untrue. This means that details may change from statement to statement, possibly growing in depth as time goes on, indicating that information is being embellished after the fact.
  • Late – Evidence that is provided late might suggest a reluctance on the part of the claimant to participate in the claim investigation process, despite wanting to proceed with the claim. This may be because they feel the evidence could belie the fact that they are being dishonest.
  • Exaggeration – If the injury being claimed seems a little too dramatic for the incident described, then this may indicate an attempt at insurance fraud. If a small shunt in a car results in the claimant then using a pair of crutches and a neck brace in public, this may appear to be ‘over the top’ and mismatched with the details provided about the way the incident occurred.
  • History – Many perpetrators of insurance fraud commit the crimes several times over, being of the opinion that it is ‘easy money.’ It is a significant sign, therefore, if the claimant has a history of making personal injury claims. In addition, if a person is known to have had financial difficulties in the recent past, this can be an indicator of a fraudulent claim.
  • Expertise – If the claimant has a high level of knowledge about the personal injury claims process of a particular insurer, this may indicate a degree of research having been carried out before the incident took place. This can be a significant indicator of attempted fraud.

Taken individually, there can be a range of perfectly innocent explanations for any of these factors being spotted during a personal injury claim. For example, evidence may be provided late because the claimant is struggling to manage their injury or is juggling medical appointments and assessments as a result of the incident. The claimant may have made a personal injury claim before because they are vulnerable to injury – which does not relieve others of the obligation to prevent such injuries occurring. Injuries may appear exaggerated, but the incident may have aggravated an existing condition which, again, does not relieve others of responsibility. The claimant may know a lot about the claims process because they, or someone they know, work in the industry. This does not mean they cannot file a claim if genuinely injured through no fault of their own.

This is why personal injury is so difficult to verify, and why it is essential for trained, experienced professionals to investigate every claim that is filed. It requires specific skill to examine and assess the factors that suggest potential fraud. In other words, it takes a trained eye to spot that a combination of signs has accumulated to the extent that further investigation is warranted.  

How do private investigators help with fraudulent injury claims?

Professional and reputable private investigators have a range of tools at their disposal that allow them to determine the veracity of a personal injury claim. This means that insurance companies, businesses, and private individuals can benefit from hiring a skilled, independent private investigation firm, where suspicions around a claim have arisen.

  • Background checks – Private investigators can conduct comprehensive background checks on a claimant to determine their recent financial situation, name and address changes, legal actions or convictions, and any history of making similar insurance claims. All of this information is gathered legally and ethically from publicly available records and presented as actionable evidence.
  • Surveillance – If a person is suspected of ‘faking’ an injury, then surveillance is an effective method of uncovering the truth. Mobile surveillance can ensure that the claimant is discreetly and covertly tracked using strategies that are entirely legal and ethical. This can generate a wealth of documentary evidence – as photographs or video – proving or disproving the injury. For example, if a claimant is seen attending a medical assessment with their arm in a sling but is later recorded dragging their wheelie bin out for collection without any injury apparent, then fraud can be demonstrated and a prosecution pursued.

By engaging the services of a private investigation firm, such as OpSec Solutions, insurance companies, businesses, or private individuals can be assured of receiving a comprehensive and verifiable package of evidence that is admissible in court. While it is often preferable to avoid costly court proceedings, court admissible evidence is, by necessity, the gold standard. This means that being in possession of such a documented package can speed up legal negotiations, resulting in an expedited resolution to the case. In instances of insurance fraud, however, criminal prosecution is warranted, and court admissible evidence is therefore required.

Both discretion and confidentiality are key to the success of fraudulent personal injury claims investigations. OpSec Solutions boasts accreditations from the Association of British Investigators, the Institute of Professional Investigators, the UK Professional Investigators Network, and the Information Commissioner’s Office, all of which demonstrate the fact that the firm adheres to a strict code of ethics defined by the protection of privacy. With a team drawn from military, police and corporate backgrounds, and headquarters in both London and Manchester, OpSec Solutions can provide highly skilled and experienced operatives and cutting edge technology across the U.K to help uncover instances of fraudulent injury claims. Contact OpSec Solutions today to arrange a free consultation about your case.


[1] https://www.abi.org.uk/news/news-articles/2020/09/detected-insurance-fraud/?timeout=s

Leave a Reply

Your email address will not be published. Required fields are marked *