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The Personality Battlefield – Avoiding Mines in Insurance Fraud Investigations

A Study Review on Insurance Fraud

by Samantha Castillo

Insurance Fraud Investigations

 

When working insurance fraud cases, our company addresses a wide range of targets, from preachers to convicted criminals. Current research, “The Dark Triad and Willingness to Commit Insurance Fraud” suggests that certain people are more likely to commit insurance fraud based upon dark personality traits (Modic et al, 2018). While it is typically not our job to make determinations about a person’s character based on our impressions or observations, we do need to take our own precautions. Each case carries its own weight and we have to be prepared in advance for any potential conflicts that may arrive whilst performing field work.

Modic et al explored the possibility that psychopathy, Machiavellianism and narcissism are linked to the increased likelihood of committing insurance fraud. These three traits comprise a “dark triad” and are distinct but overlapping constructs, which help in explaining a variety of behaviors typically viewed as unethical, blameworthy, deceitful, manipulative or self-centered (Modic et al, 2018). As investigators, we spend most of our time in close proximity to or interacting with our subjects in the field. A crucial part of preparing for these interactions or observations is to conduct a survey of the target’s (or subject’s) criminal history and past indiscretions; creating a basis for the level of aggressiveness that we can put forth.

By producing an environment where participants could make simulated insurance claims, Modic et al hailed results by two methods. The first method introduced items for claim without any circumstances around how the items were damaged. The second introduced another layer to the equation, whereas the item was damaged while the claimant was drunk, angry or it was damaged purely by accident.  The study created a baseline for fibbing with the first method and then went a step further by introducing the monetary incentives and situational factors (Modic et al, 2018). When the results of their study were evaluated, Modic et al found that the dark triad of traits has an impact on one’s likeliness to commit insurance fraud, more so the traits as a whole construct are more influential than the individual traits themselves.

What does this mean for insurance fraud investigations though? It cannot be concluded that all people that participate in fraudulent claims perpetually have one or all of those three dark traits, but we can use the possibility that a trait was present at the time of the claim. According to Modic et al, it is possible that situations that elicit anger or frustration increase the likelihood of fraudulent behavior, especially in individuals with high psychopathy (2018). The majority of the insurance claims that we see stem from an accident that caused supposed great physical or emotional damage to the claimant. It would be daft to not assume that the situation involves an element of anger or frustration.

High level claims that involve large monetary payouts, can many times carry an elaborate production from the claimant. Trying to catch a target in this production is the riskiest part of an investigator’s task. We want to get that target both using and not using that brace, crutches, or wheelchair. When we interview them, we want to ask questions that will provoke answers that stand out as controversial to any prior statements or claims they have made. But in doing this, what happens when you finally catch someone in a lie? How will they react?

These questions reiterate the importance of getting to know your subject’s temperament. Arrest and conviction records, social media, driving records, marriage and divorce records, child support or custody records, bankruptcy and foreclosure records, eviction records, police reports, and  prior interactions with other agencies; all of these things can be sorted through in order to build a profile and action plan for investigators in the field. The last thing that is wanted is for an investigator to find themselves in a position of danger or to wind up ruining a case. The goal should always be to maximize our opportunity! Ultimately, each step we take as investigators should not be impromptu and learning to make informed decisions is what it’s all about.

 

References

Modic et al., Cogent Psychology (2018), 5: 1469579 https://doi.org/10.1080/23311908.2018.1469579