Insurance fraud at the forefront

Blackfin

Blackfin

Well-known member
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Blackfin said:
Don't know if this will result in any big upheaval in the "insurance claim economy" that's a large part of why insurance costs are so out of control in this province but it's good to see fraud being looked at by the media (W5 in this case), the companies (Aviva) and, hopefully, local police, OPP and/or RCMP.

http://www.ctvnews.ca/w5/undercover...-into-possible-auto-insurance-fraud-1.2812297
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I saw that program.

Aviva got lucky in that the claimant actually admitted that he had not undergone any medical treatment, and that he had been coached on what to say and how to act in order to get an insurance payout. Otherwise, all Aviva would have had to go on was unproven suspicions.

Think about the amount of time and resources Aviva spent to get the evidence on this one pair of physio and paralegal fraudsters. Think about the amount of fraud out there.

While it's great that they were able to (hopefully) shut down this particular pair of fraudsters, it's just a drop in the ocean. Unless the number of such investigations yielding similar results increases dramatically, little will change. And given that time and resources needed to get such results is high, can the insurance companies ramp up their investigative efforts in the vast majority of claims where there are no such clear signs of fraudulent activity, as was the case in the claim that was the subject of the W5 program.
 
I agree, but this sort of coverage can only help. Maybe one story leads to another and another, maybe social media starts to play a role. I dunno. It's better than no coverage and no fruitful investigations.

Maybe some serious penalties on these perps could incentivize others to voluntarily change their ways lest they face similar consequences.

We can always hope.
 
I think Ins fraud has been going on since insurance was first offered a few hundred years ago. If it carried stiffer penalty it may slow it down.
 
griff2 said:
I saw that program.

Aviva got lucky in that the claimant actually admitted that he had not undergone any medical treatment, and that he had been coached on what to say and how to act in order to get an insurance payout. Otherwise, all Aviva would have had to go on was unproven suspicions.

Think about the amount of time and resources Aviva spent to get the evidence on this one pair of physio and paralegal fraudsters. Think about the amount of fraud out there.

While it's great that they were able to (hopefully) shut down this particular pair of fraudsters, it's just a drop in the ocean. Unless the number of such investigations yielding similar results increases dramatically, little will change. And given that time and resources needed to get such results is high, can the insurance companies ramp up their investigative efforts in the vast majority of claims where there are no such clear signs of fraudulent activity, as was the case in the claim that was the subject of the W5 program.
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What if the insurance companies were forced to crack down rather than just increase rates for compensation? I mean, something like they had to prove that they were trying to go after the fraudsters before they were allowed to increase premiums.

Sent from a Samsung Galaxy far, far away using Tapatalk
 
Insurance companies are taking the easy way out, instead of hiring a private investigator & dealing with the issue they are simply increasing rates. The government is to blame too, this is a criminal act & should be given attention, instead they are turning a blind eye. Kinda like motorcycle thieves
 
Joe Bass said:
What if the insurance companies were forced to crack down rather than just increase rates for compensation? I mean, something like they had to prove that they were trying to go after the fraudsters before they were allowed to increase premiums.

Sent from a Samsung Galaxy far, far away using Tapatalk
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How would they be able to sufficiently "prove" they were going after fraudsters? By presuming that most or even many claims are suspect, and in doing so delaying and even denying settlement to even legitimate claims in the process until a full investigation is done on those claims?

Who ultimately would end up most inconvenienced by such an approach? Who ultimately would end up paying for the costs arising from delayed claims payout and the costs of investigation?
 
RockerGuy said:
Insurance companies are taking the easy way out, instead of hiring a private investigator & dealing with the issue they are simply increasing rates. The government is to blame too, this is a criminal act & should be given attention, instead they are turning a blind eye. Kinda like motorcycle thieves
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Insurance companies are already the heaviest consumers of private investigation services. PI services cost money. Insurance companies pass on the costs of business through, you guessed it, premiums charged to insurance purchasers.
 
griff2 said:
How would they be able to sufficiently "prove" they were going after fraudsters? By presuming that most or even many claims are suspect, and in doing so delaying and even denying settlement to even legitimate claims in the process until a full investigation is done on those claims?

Who ultimately would end up most inconvenienced by such an approach? Who ultimately would end up paying for the costs arising from delayed claims payout and the costs of investigation?
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I never said that it was well thought out.

Sent from a Samsung Galaxy far, far away using Tapatalk
 
griff2 said:
Insurance companies are already the heaviest consumers of private investigation services. PI services cost money. Insurance companies pass on the costs of business through, you guessed it, premiums charged to insurance purchasers.
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Pay the PI or pay the thieves? Paying the a PI is a one time high rate. After they get caught, there will be less fraud. Plus I would rather pay the pi than the thieves
 
Here is the thing. The laws prevent insurance companies from suspending payments for claims due to suspected fraud.

So they may think it's fraud but they have to pay.

Insurance companies do work with LE and have PI firms investigating.

But the resources to prove and bring convictions is difficult. And recovery of pay outs non existent.

Once the instance companies can suspect payments, you'll hear howling about high insurance rates, getting ripped off AND people being denied benefits.

So the system we have in place is what it is.




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