Insurance Fraud Indicators

Insurance companies consider some claim components to be possible insurance fraud indicators. Insurance fraud is defined as “any act committed with the intent to fraudulently obtain payment from an insurer”. ( It is a crime. Insurance fraud is just not worth the effort. Trust us, you’ll get caught, and it is a crime punishable by heavy fines and/or jail time. If you trigger one of these key fraud indicators when pursuing a personal injury claim, your claim will probably be referred to the company’s Special Investigative Unit (SIU) and will become one huge headache.

• The damages to your vehicle are so minor as to make the likelihood of any occupant being injured very low.

• You are excessively eager to accept blame, or are very pushy and demanding of quick settlement, even offering to accept a reduced settlement in return for not submitting all of your damages (presumably because you don’t have any).

• You are unusually familiar with insurance lingo, terminology and procedures.

• You refuse to share more than a post office box or a hotel as an address, or are “staying with a friend”.

• You avoid using the mail, email or even the telephone, preferring to conduct all of your business in person.

• You are presenting a non-typical accident description.

• You use threatening or bullying negotiation techniques, such as threatening to hire an attorney or seek additional medical treatment if your claim is not quickly settled.

• You claim multiple injuries and/or extensive property damage to your vehicle, yet no police were called to the scene.

• The damages occurred shortly after the inception of a new insurance policy.

• You and/or your passengers have a history of accidents within a short period of time.

• You hire an attorney immediately.

• There is a dispute between you and the other driver as to how many people occupied your vehicle at the time of the accident.

• The other driver disputes that any accident actually occurred.

• There is a long delay between the time of the accident and the date that you begin treatment for your injuries.

• Your statement of damages changes.

• Your medical bills and/or lost wage documentation appear falsified or altered.

This list is incomplete as each claim is unique. If anything you report to the adjuster just seems “fishy”, and he or she has the time, they will take a closer look at your case.

This article is written for informational purposes and is not intended to take the place of competent local legal counsel.

Other articles related to this issue:

The Insurance Claims Process explained.

Is it Necessary to Hire an Attorney to Handle Your Case?

The Insurance Company's Special Investigative Unit

Insurance Company Surveilance

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