Insurance investigators estimate fraud to be estimated to cost up to $2.2 billion every year, which is directly affecting premiums for genuine policyholders.
Sydney, brisbane, Gold Coast
The Insurance Fraud Bureau of Australia estimates that in 2017, insurers detected $280 million in fraudulent claims in all classes of insurance, excluding WorkCover, CTP and Personal Injury claims. These figures are only what has been identified, and we know the amount is significantly more than that.
Insurance fraud affects those that have legitimate claims! Although insurers have systems in place to red flag suspect insurance claims, it is still necessary to conduct an insurance investigation to determine fraud and liability. Without detecting fraud, premiums for those individuals and business will continue to increase to counter balance the loss to insurers.
Prime Investigations has been conducting insurance investigations into all areas of insurance including WorkCover, CTP, Public Liability, Personal Injury, Income Protection and Fire & Theft claims. All of our insurance investigators have years of experience in their respective fields.
variations of fraudulent claims
An insurance claim that is deliberately fraudulent is calculated and planned. The idea is to deceive the insurer and receive a payout or payments over time. For example, a policyholder along with another person stages a car accident, or burns down a house, or fakes a theft. This is not uncommon in the insurance world. This generally occurs more when the economy is down.
In this instance, the claimant does have a legitimate injury, or claim but then deliberately exxagarets the injury or the damage to assets. This is done to increase the payout figure. This can be quite common in CTP claims where the claimant will allege greater injury and impact to their lives to increase the payout considerably. Also common in WorkCover claims.
This means that the claimant or policyholder has not provided all information to the insurer. It is quite common with personal injury claims, where the injury may be pre-existing or in the case of WorkCover, happened outside of the workplace. This also happens with vehicle insurance where the driver’s previous history is not disclosed.
quality Insurance Investigators
For more than a decade, we have been providing insurance investigations for self insurers, solicitors and businesses relating to WorkCover, CTP, Public Liability and Vehicle Accident Claims.
Investigating insurance claims to identify fraud or legitimacy requires an investigator with a good head on their shoulders and experience in making the relevant inquiries.
Our insurance investigators are smart, well spoken and experienced in handling many types of insurance related investigations. These attributes are especially important when handling claims where a physiological injury has been alleged.
Claims we investigate
There are many forms of insurance these days and each one requires a different approach when it comes to investigating the claim and providing a factual report so qualified specialists can make a determination of liability.
We do not use inexperienced investigators to handle insurance related matters. Each investigator on our team has at least 5 years experience in their respective fields. Let us handle your next matter.
The three cores services that are used to investigate insurance claims are below. Depending on what our clients requirements are, we are able to assign an investigator with these specific skills to investigate and report back. We provide professional reports for those qualified to make a judgement on the matter as to liability.
A well planned surveillance operation can be very effective in gathering hard evidence in relation to insurance matters. Each agent we use has at least 5 years experience in the field and with insurance related matters. A good surveillance agent remains discreet and doesn’t alert people nearby as to their activities.
A good factual investigator has many attributes. The process of interviewing related parties, asking the right questions, appearing sensitive toward claimants etc are all part of conducting a professional investigation. Our factual investigators are smart, well mannered, professional, well spoken and have good writing skills.
Online intelligence gathering, otherwise known as OSINT has proven to be very effective in helping to better understand someones background and activities. This can include their financial status, other employment, sporting activities and more, which can all be very helpful in determining the legitimacy of a claim.