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Insurance & Fraud InvestigationsGenerally, fraud
and insurance fraud are any deceitful or dishonest conduct, involving acts or omissions or the
making of false statements, orally or in writing, with the object of
obtaining money or other benefit from, or evading a liability. In general
terms fraud is the use of deceit to obtain an advantage or avoid an
obligation. Proving fraud, whether it be against an insurer, or an
employer, is more important today than ever before. Insurance fraud can cover a wide subject area and can be perpetrated by employees and former employees of a company trying to obtain money from a insurance company for an injury related or not related to work. A major percentage of claims (90%) are passed through without investigating the claimant for authenticity. Other forms of fraud, like internal fraud, are perpetrated from within an organization by employees and can involve false accounting, direct theft of cash, payroll fraud, theft of intellectual property, false expense claims, collusion with customers & suppliers, inventory loses, and reporting of excessive overtime. Some cases of internal fraud have collusion from outside third parties. Many cases of internal fraud go unreported because of the potential embarrassment and risk liability involved. Frequently, fraud investigations may incorporate other investigative services such as background investigation, asset investigation, social security investigations, people locates, and surveillance.
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Many
workers just assume that if they lose their job there will be some form
of insurance that will pickup when their job leaves town, and when
unemployment benefits run out, they get desperate and try for creative
means of support.