Insurance Claims Investigations

How private investigators impact the bottom line:

A thorough and professional investigation can strengthen an insurer's position.

If an investigation reveals material misrepresentation

• The insurer has the right to cancel the policy.
• The insurance company can take an off-coverage position .
• The insurer can sue the for the amount of money already paid out for the claim and for costs and damages.
• Criminal charges could result from fraudulent claims, which could make it difficult for guilty parties. Criminal charges and policy cancellations give the insurance companies the ability and right to refuse to sell insurance to people with a prior history of fradulent claims.

Common automobile insurance fraud detected by private investigators:

Unethical auto repair shops. After bring involed in a motor vehicle accident, the stress and burden of auto claim on top of any injuries that may be sustained can be overwhelming. Unfortunatley, claimants without extensive knowledge of vehicles during this time are vulnerable to be taken advantage of by auto collision shops. The auto collision repair shop could exploit this opportunity to overbill and inflate costs, perhaps billing for repairs never completed, services never provided, or parts never installed. Perhaps the mechanic will purposely perform substandard work, knowing the driver will need to return at some point for additional services. These concerns are warranted as such events do happen - professional investigators conducting undercover surveillance operations are able to flush out such fraud in a manner that provides legal evidence, not simply information alone.

Fraud Rings - Collusion between claimants, auto collision shops, tow truck drivers. Fraud rings are a very real and active in Ontario. Crow Private Investigators has worked with various SIU investigators in an attempt to 'bring down' fraud rings by trying to identify the responsible persons in the ring. This type of investigation starts with the insurance claims adjuster. It is up to the PD and AB adjusters to analyse the case, talk to the claimants, and identify any red flags. This due diligence is a must, otherwise fraud rings can continue to siphon money form the insurers. After red flags are identified, the SIU department must then conduct their own internal investigation. What is most important about this part of the investigation is discretion. A call from the SIU department to an auto shop or a claimant could make the parties involved conspire to ensure their stories are straight. So getting a quality private investigator involved will help to maintain discretion and maximize chances of getting hard evidence.

Staged accidents. Another common type of automobile fraud is when a vehicle driver will purposely crash their vehicle or have some form of accident, often involving another unsuspecting driver. Sometimes multiple occupants in one vehicle are in collusion and the third party may be an innocent victim in the staged accident. Claimants may also claim pre-existing or non-existing injuries as being inflicted as the result of the accident.

IPSOS Survey on how Ontarians perceive auto insurance fraud:

[IPSOS was commissioned by the Ontario Government in 2017 to conduct a survey of Ontario drivers][0] and learn about their perceptions of automobile insurance fraud.

• Valid concerns were established about the ability of Ontario drivers to recognize and report auto insurance fraud
• Older drivers aged 55 + knew most about insurance fraud (86%)
• Millennial drivers aged 18‑34 knew least about fraud (56%)
• 11% of respondants were actually willing to report that a family member had made an exaggerated or false claim. It is reasonable to believe that a higher percentage were aware of false claims being committed but did not wish to potentially expose themselves.
• Of this 11%, the most popular auto insurance scam reported, coming in at 5%, was intentionally influencing an automobile body repair shop to overbill or add in services never rendered.
• 35% of respondents said they did not know that insurance fraud is a federal criminal offence!
• Almost 1 in every 10 respondents acknowledged they had personally submitted an exaggerated or false claim. Again, it is reasonable to believe that even more had committed this offence, but did not wish to expose this information to the researchers.