Leveraging Background Investigations to Mitigate Abuse and Fraud in Insurance Claims

In the domain of insurance claims, the importance of thorough background investigations cannot be overstated. At Frasco, we specialize in conducting comprehensive background investigations to assess the credibility of those individuals being investigated and helping to mitigate abuse and fraud in workers’ compensation and other types of insurance claims. By leveraging detailed background investigations, we provide insurance claims professionals and risk managers with the critical information needed to make informed decisions.

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The Importance of Thorough Background Investigations

Conducting thorough background investigations is essential for reasons that include:

• Credibility Assessment: Verifying the information provided by those that file insurance claims help in assessing their credibility. This includes comparing data gathered during background record research with the facts and allegations of the insurance claim. Consider one example where the insurance claim allegations directly conflicted with Social Media posts previously made by the claimant.
• Abuse and Fraud Prevention: Information developed during background investigations can uncover facts that may indicate abuse of the insurance claim process or even fraudulent activity.? Consider one example where a claimant was found to be working as a real estate agent despite alleging that they were unable to leave their home due to injuries sustained during the automobile accident that led to the insurance claim.

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Components of a Comprehensive Background Investigation

Background investigations should be tailored to the specific insurance claim and can include a wide range of data sources to ensure a thorough investigation.? A few types of data sources often included in a background investigation include the following, many of which are accessed online or onsite where the records are housed:

• Driving and Vehicle Registration Records
• Real Property Ownership Records
• Comprehensive Address History Records
• Civil Court Records
• Criminal Court Records
• Civil Court Judgments, Liens, and UCC filings
• Bankruptcy Court Records
• Employment Records
• Business Ownership Records
• Professional Licenses
• Litigated Workers’ Compensation Injury Records
• Sex Offender Records

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Case Study: Insurance Claim Investigation

Consider a recent case where our background investigation proved invaluable. An insurance company received a claim for a significant loss due to a covered accident. The subject reported substantial financial losses and requested a large payout.

We conducted a comprehensive background investigation, which included verifying the subject’s provided information, checking their driving and vehicle registration records, and reviewing real property records. Our investigation revealed that the subject had recently purchased several high-value assets, including a luxury vehicle and a boat, which were not disclosed in the claim details. Additionally, we uncovered a history of financial instability, including multiple bankruptcies and significant outstanding debts.

The detailed background check provided irrefutable evidence that the insured had withheld key details relevant to the claim. This information led to a more thorough investigation, ultimately resulting in the denial of the claim and saving the insurance company a substantial amount of money.

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Conclusion

Thorough background investigations are a cornerstone of effective risk management in insurance claims. By leveraging comprehensive background check services, insurance claims professionals and risk managers can make informed decisions, reduce potential risks, and prevent fraudulent claims. Our commitment to excellence ensures that we provide reliable and detailed information, enhancing the integrity of the insurance industry.