Criminal Justice Degree - Preventing insurance fraud

Insurance Fraud

When you think of a degree in criminal justice, you may not even consider other careers besides law enforcement but there are many more crimes that need investigated by skilled and educated individuals. One of those career opportunities is working for an insurance company.

There are numerous forms of fraudulent claims that people present to insurance companies. The increased number of fraudulent claims has increased the premiums of every insurance customer. As costs increase for insurance companies to pay these claims, the company increases premiums across the board in an attempt to decrease their losses.

Auto Injury investigations

According to the Coalition Against Insurance Fraud, fraudulent and "build-up" injury claims cost insurance companies an additional 4.6 billion dollars. A build up injury claim is one in which the person continues to seek treatment long after any injury should have been corrected. For example, a "whip-lash" (or cervical sprain/strain) injury, should take no longer than 8 weeks to heal, but the injured will continue to claim injury and go to treatment for many months after.

One of the most common fraudulent claims and the most difficult to disprove is the car accident injury claim. There is no doubt that thousands of people are legitimately injured during car accidents every year, however, there are those who see a minor fender bender as an opportunity to cash in on an injury claim. These are generally termed as "soft tissue" injuries, where there is no visible injury to the person. The problem is that they can tell their doctors they hurt and can't function normally, and the doctor cannot dispute this claim, but only treat the symptoms the person is claiming.

For example, two cars are stopped at a stoplight; the person in back accidentally releases their foot from the brake and rolls into the car in front thus causing a silver dollar size dent in the bumper. Extremely low speed, very minor damage to vehicle, but the driver in front claims they now have back and/or neck injuries that are soft tissue only. The x-rays and doctor sees no visible sign of injury, but the doctor cannot call the patient a liar and is forced to treat the "injury". This is then billed to the insurance company and the driver gets the bills paid plus money for pain and suffering.

The only way to combat these types of false claims is through investigative techniques. Many insurance companies have investigators who do nothing but obtain photos and evidence that a person is not truly injured. Using the same example as above, the investigator may obtain photos of the person out bowling, or working in a garden, or doing any type of strenuous activity that wouldn't be possible given the nature of the injury that is being claimed.

This is not to say that insurance companies are attempting to avoid payment to those who are genuinely injured, quite the contrary, they want to pay those who are injured and deserve restitution. But they are also willing to investigate possible fraudulent claims in order to keep the premiums of the honest population as low as possible.

Hit and Run investigations

Another common fraudulent claim is the hit and run driver. These claims can be fraudulent in two ways, the first being the actual hit and run driver that flees the scene. This driver is committing fraud by simply leaving the scene of the crime. The second are customers who may call in a claim that, while they were parked, a car side-swiped them. Many hit and run driver calls are legitimate, but there are those who will actually hit a car, fence or pole and flee the scene (perhaps because of drinking and driving, or simply to avoid an at fault accident on their policy), then attempt to claim later on that they were parked and someone hit them.

This can be a very difficult fraud to prove. One of the first things that an investigator may look for is closed circuit surveillance. If there is anyone in the area that has CCTV, such as a bank, gas station or other building or private security system, then there may be a way to identify either the vehicle that committed the hit and run, or the fact that there was no other vehicle involved. The second, and perhaps more important means of getting the truth, is knocking on doors and talking to neighbors. It is not unusual to find out that the damages have been on the car for quite some time and the insured told them a different story about how the damages occurred.

Investigating Fire Claims

Another claim that is closely monitored for fraud is the fire claim. Anytime a fire claim is presented, either with a car fire, house fire or business fire, it is closely investigated. This is because, according to the Coalition Against Insurance Fraud, over 500,000 claims, or 1 out of every 4, fire claims are found be arson, or suspected as arson.

Fire can quickly consume and destroy a building or car so it is not uncommon for people facing financial difficulty to attempt to get out from under payments by committing arson. Generally, after a fire, the house or vehicle is a total loss, the person then gets paid the value of the item. They then either pay off any outstanding debts owed on the property, or if they own it out right, they use the money for other things.

The initial start to a fire investigation involves a lengthy and very detailed recorded statement with the insured. During this interview, the investigator will ask questions about the fire, where it started, when it started, who was there, did anyone see it, etc. However, they will go beyond that and ask some very personal questions regarding income, debts, credit scores, money problems, interpersonal relationships, etc. All of these things can lead to a motive for arson.

An insurance investigator will also go to the scene and obtain photos of the property that was damaged, as well as look for specific reactions within the property that may indicate arson rather than accidental fire.

The investigator will work with the fire department and arson investigators to determine the cause of the fire as officially reported. If there is any question by the local or state arson investigator, then the insurance investigator proceeds with a recorded deposition face to face with the insured.

Other types of fraud investigation

There are many types of fraud investigators needed, and a degree in criminal justice can help you land a career in this exciting field. For example: worker's compensation fraud, health insurance fraud, and disability fraud to name a few.

There are many different ways to investigate different types of frauds depending on the claim being presented. Workers compensation and disability frauds take a lot of patience and can mean a lot of "staking out" the suspected fraudulent claimant. But for every case that is fraudulent and is proven as such, the investigator is protecting the rest of us from absorbent insurance increases.

What can I do to get into this career?

Most people may think that working for an insurance company would seem boring. Quite the contrary, working as an investigator for an insurance company provides a great satisfaction to those who suspect, investigate and prove fraudulent cases. They also get a great deal of satisfaction in paying those who have legitimate claims and are deserving of compensation for injuries and/or property reimbursement.

If you have considered a degree in Criminal Justice, but do not wish to work as a police officer or corrections officer, then consider a career investigating insurance frauds. Many colleges offer criminal justice degrees either on campus or via online education. With online education, you can study when it is convenient for you from the comfort of your own home. The first step is to look at different colleges and determine which one best suits your needs.


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