Insurance is designed to compensate someone in the event of loss. A real loss that is. Unfortunately for many, defrauding an insurance company is there way of making money. In Michigan, we face a wide variety of casualty related fraud risks. PIP fraud, or first party auto fraud, bodily injury fraud, otherwise known as third party liability fraud and workers compensation fraud are all common ways of making money by faking an injury. Michigan, like many other states has some cities like Detroit, Dearborn, Warren, Flint, and Muskegon where there is a greater than average instance of auto insurance fraud.
At Sherlock Investigations, we know that information is power and we know Michigan insurance fraud. That’s why our team of private investigators is dedicated to uncovering the answers that help carriers and self-insured entities to fight insurance fraud and to make claims decisions based on facts. We have a dedicated field staff of specially trained investigators, located strategically throughout Michigan, with the primary objective of investigating and gathering evidence of suspect casualty claims.
Fraud makes insurance more expensive for everyone.
Recent studies have determined that insurance fraud in the property and casualty industry has reached an estimated $80 billion annually. This costs the average U.S. family $950 a year in increased premium and taxes.* But beyond the high dollar costs, insurance fraud can also damage or ruin people’s businesses, careers and families.
How serious is the Michigan insurance fraud problem?Insurance fraud is one of the most costly white collar crimes in America, ranking second to tax evasion. According to the National Insurance Crime Bureau (NICB), 10 percent of property and casualty insurance claims are fraudulent.
In Michigan, insurance fraud perpetrators can be members of complex organized fraud rings or a neighbor looking for additional income. People who would never think of committing a crime can find the temptations of claim money from insurance fraud hard to resist.
No matter what the reason behind fraud, we at Sherlock have the experience, training and tools to help insurers to mitigate unnecessary loses and to effectively fight fraudulent insurance claims in Michigan.
Here are some examples of PIP, BI, Liability and Workers Compensation insurance fraud in Michigan:
Staged or caused accidents
They may involve one or more vehicles and individuals causing a collision with an innocent driver who ultimately appears to be at fault.
Swoop
“Swoop” vehicle swerves in front of “squat” vehicle causing “squat” vehicle to slam on its brakes, which causes a rear-end collision with the victim’s vehicle.
Sudden Stop
“Squat” vehicle slows down to close gap between his or her vehicle and the victim’s vehicle, then brakes suddenly causing a rear-end collision with victim.
Backing
Victim’s vehicle collides with suspect’s vehicle while backing out of a driveway or while backing out of a parking space in a parking lot.
Right of Way
Suspect driver appears to give right-of-way to victim driver, usually in an intersection, causing vehicles to collide; suspect later claims no right-of-way was offered.
Phantom Vehicle
Solo vehicle crashes due to vehicle of unknown origin/description.
Hit and Run
“Hit and run” vehicle strikes victim’s car and leaves scene of the accident.
Paper accidents
The accident only exists on paper. A vehicle may have pre-existing damage which is claimed as occurring during the purported collision. Parties conspire to create illusion of legitimate accident using either pre-damaged vehicles or by intentionally and covertly inflicting damage on the suspect’s vehicle(s). Generally, law enforcement is not called to the scene of the accident.
Faked and or Inflated Damages
Damages to vehicle exaggerated, non-existent, inflated, pre-existing or vehicle damaged at a later point in time.
Organized Claim Fraud Ring
Collision(s) orchestrated by organized criminal activity involving attorneys, doctors, other medical professionals, office administrators and/or runners and cappers.
Exaggerated injury claims
These may result from a staged or caused collision or a fabricated accident at retail establishment.
Owner give-up
Vehicle owner makes a false report that their vehicle was stolen in order to recover insurance money.
Premium Theft
The single most prevalent type of agent misconduct Instances can range from a single theft of minimal amounts to multi-million dollar scams perpetrated on the public and the insurance industry.
Health care fraud
Medical provider’s bill insurance companies for services not rendered or unneeded tests and procedures.
Provider Fraud
Medical provider knowingly submits false medical bills by billing for services not rendered, billing for wrong procedure codes or billing for procedures of a medical necessity when procedures may have been elective or cosmetic in nature and not covered by health insurance
Disability
Disability claim submitted against disability insurance policy while claimant on permanent or temporary disability and receiving continual benefits and/or vocational benefits and/or claimant reported working or performing activities exceeding alleged physical limitations.
Inflated Billing
Inflated billing by any medical facility, doctor, chiropractor, laboratory, etc.
Padding or inflating an insurance claim
May involve any type of insurance but most commonly occurs with homeowners and auto claims. Generally, these are legitimate claims where additional lost property or damages are reported to increase the claim or offset the insured’s deductible.
Workers’ Compensation Fraud
Suspicious employee applicant claim, working and drawing benefits.
