#insuranceclaims

Insurance Fraud

 

The act of misleading an insurance company to receive insurance benefits or payouts to which one is not entitled is referred to as Insurance Fraud. Insurance Fraud is a major issue for the insurance sector, as it results in significant financial losses and leads to higher rates for policyholders. Fraudsters often resort to fabricating evidence to support their false claims. In the realm of insurance investigations, uncovering the truth behind insurance claims is of utmost importance. Insurance investigations play a critical role in ensuring the validity of insurance claims and combating fraud. To ascertain the legitimacy and accuracy of insurance claims, investigators employ a meticulous approach. 

Insurance companies often turn to Forensic Investigators for cases that raise suspicion even after conducting their own due diligence activities. One crucial aspect of forensic investigation is trace evidence analysis, where physical evidence in the form of trace materials and minute features can provide tangible and unbiased information about the incident. By examining tiny particles and materials present at the scene, trace evidence analysis can effectively expose inconsistencies and falsehoods, shedding light on the background of the incident. These trace elements encompass a wide range of microscopic materials found at the scene, such as glass fragments, paint chips, fibers, soil, cloth, paper, and other microscopic substances. Through the examination of trace evidence, investigators can establish connections between assets, individuals, and situations. They can evaluate whether the incident aligns with the physical evidence and verify or debunk the veracity of the claims made by the claimants. 

The specific types of trace evidence, their conditions, and their positioning serve as indicators of the events that transpired during the incident. For example, the presence of hydrocarbons in a fire accident may indicate foul play. The type of trace evidence discovered at incident scenes varies depending on the case and the nature of the accident. Discrepancies between the alleged event or claim and the presence of incriminating trace evidence can raise suspicions, prompting further investigation into such claims. This helps investigators and insurance companies identify false claims. 

The investigation using trace evidence must be conducted with great care, as the quantity of the samples is often minuscule, and the quality is typically perishable. The extent and quality of the analysis heavily rely on the proper collection and preservation of the samples. Once the trace evidence is collected, it is sent for physico-chemical (PC) analysis, which utilizes various instrumentation techniques such as microscopy, spectroscopy, chromatography, and more, to provide qualitative and quantitative analysis. 

Trace evidence analysis plays a vital role in revealing the circumstances of the incident and enables investigators to assess the validity of insurance claims. Through meticulous analysis and interpretation of trace elements, connections are established, authenticity is confirmed, events are reconstructed, and fraudulent activity is exposed. Collaborating with forensic specialists and employing cutting-edge scientific methodologies empowers insurance investigators and surveyors, leading to fair claim settlements. 

Truth Labs has been at the forefront of assisting public and private sector insurance firms in upholding integrity, defending honest policyholders, and ensuring that justice is served. By utilizing trace evidence analysis as an effective tool in numerous investigations, Truth Labs has saved billions of public and private funds from fraudulent activities. 

Investigating Insurance Fraud.

 

Accounts of an incident from the word of a witness and a victim is considered a key evidence for an investigation. But it is paramount to test the reliability of the said statement, and ensure the facts align with the presented evidences. However, in some cases, the individuals not only provide murky statements, but intentionally make an effort and to bulldoze the case. Typically, this is prevalent in cases where the victims/ witnesses are involved in underhanded activities that could be uncovered by the investigation.  Such cases are often found in the insurance claim investigations that are referred to Truth Labs involving insurance fraud.

Truth Labs was approached with a case concerning insurance claim by a garment and textile proprietary firm owned by a formidable woman. A force so reckoning, even investigators could have a chill down their spines in her presence.

In a two story building, the fire had affected floor 1 in an isolated manner. The investigators were shown a scattered pattern of scorched floor along with disturbed furniture and a soupcon of debris deposition not corresponding with the insured claim of destroyed goods.

The victim in question was the owner of the store, who claimed that sometime on a Sunday a significant portion of her stock was burned down and she faced a substantial loss. Unfortunately, there were no records of inventory or any such material evidence as the only available computer, lacked a motherboard and hard disk. Adding to the inconvenience, the CCTV footage for the period of fire was also to be not recorded due to no electricity and the corresponding DVR was sent to a government forensic lab by the police.

But it wasn’t the minimal evidence that hindered our investigators, which was not nearly as impeding as the looming presence of the owner. The interviewing of the witnesses was severely influenced by the owners and her sway over the neighbouring vendors was astonishing. They sounded reluctant and deliberately confused about the events surrounding the fire.

Upon investigation, it was noted that the fire travel path and the burn patterns were unusual and the positioning of the items and clothes as narrated by the insured was found to be discordant with the physical trace of the fire. The reconstructive inference excluded possibilities of electrical or accidental fires. The physicochemical analysis of the debris reported hydrocarbons indicating the presence of petrochemicals. The witness statements were flimsy and uncorroborated with each other.

All in all, the evidences found indicated foul play which was concluded that the fire which has multiple points of origin was initiated by human ignition. Our report then helped the insurance company close their case in a swift and efficient manner