Insurance Claims Investigations
OUR SERVICES
OUR POSITIVE DIFFERENCE
INSURANCE CLAIMS EXPERIENCE
Our principal investigator is a former AB adjuster so we understand the claims process.
Each investigation is strategically planned to maximize results and ensure utmost discretion.
MUTUAL INSURANCE CLAIMS
We work closely with Ontario Mutual Insurer’s and know that many Mutual Insurance Claims investigations are conducted in rural areas or smaller towns, so we employ investigators who know how to get results in those areas.
Insurance Surveillance Investigations
Insurance surveillance experts
Quality and impartial evidence makes the difference
Private investigators act as the eyes of the insurers. Crow provides impartial evidence so insurers can adjudicate their claims effectively.
Crow has a reputation for obtaining extraordinary results for their clients which has mitigated unwarranted payouts and legal costs.
Our philosophy is to be discrete and avoid detection at all times. We employ advanced covert surveillance tactics with only experienced and qualified licensed private investigators.
Crow private investigators uses high-tech equipment and communication devices to ensure results are the best in the industry.
Special Investigations Unit Support
Preparation, Execution, Communication
Due diligence is performed on every file, but SIU investigations are more complex and therefore require greater attention to detail and an enhanced level of discretion.
Our team then works together to execute our plan in a discrete and professional manner.
All SIU investigations are managed by our agency’s Principal Investigator who communicates directly with clients regarding the progress of the investigation.
Open Source Intelligence (OSINT)
Great Investigators know how to find the right information.
OSINT is any information that can be found online, including social media profiles, posts, tweets, shares, images, historical blogs, and articles.
Our efficient OSINT investigators often develop entire profiles of Subjects using OSINT techniques. Such information can include family details, associations, employment details, and credibility issues, to name a few. When the developed OSINT is corroborated with observations made by our surveillance investigators, it strengthens our evidence for use in court.
PRIVATE INVESTIGATORS REDUCE RESERVES AND HELP DETERMINE EXPOSURE.
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.
SEEN ENOUGH?
Contact Crow Investigators today to assist in
your Insurance Claim Investigations
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1-888-951-9595
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OUR INSIGHTS
What do insurance investigators do?
There are many ways private investigators can aid insurance companies in determining the legitimacy of claims.
Private investigators work in collaboration with insurance adjustors.
Based on the nature and scope of an insurance claim, an investigative plan is created then executed quickly and discretely.
Evidence is obtained in an impartial manner, recorded carefully in high quality, and accompanied by a professionally written report.
FRAUD QUESTIONS & RESOURCES
What is insurance fraud?
The Government of Canada defines insurance fraud as, “any act committed with the intent to fraudulently obtain payment from an insure.” When a person intentionally deceives an insurance provider with the goal of attaining money or other benefits they are not rightfully entitled to receive, insurance fraud is committed according to the Canadian Criminal Code R.S.C., 1985, section 380 subsection 2.
What are some examples of insurance fraud?
1. Overinflating Tow, Store, & Dent Costs
Towing companies and automobile repair shops with unethical business practices will either baselessly raise their costs, or, do so intentionally in collusion with insurance scammers for a share in the claim payout amounts.
2. Signing Blank Medical Claims Forms
Medical clinic staff ask claimants to provide their signatures on blank accident benefit forms. Then they complete the form listing services that were not actually provided. Sometimes these clinics even forge signatures of legitimate medical practitioners on these forms, billing insurers for services never rendered.
3. Staged Motor Vehicle Accidents
A vehicle accident is intentionally planned and executed. An automobile collision is staged, usually with an unsuspecting driver. The party behind the staged MVA makes it appear as if the unsuspecting driver is at fault, putting forward a false claim.
4. Providing Misleading Information
An individual provides false information to an automobile insurer, for example vehicle information or address. Policy misrepresentation occurs when the individual selectively chooses information that reduces the risk profile, thus lowering the auto insurance costs.
5. Stolen Vehicle Market
An automobile is stolen every 7 seconds in Canada. Insurers pay over $550 million each year to replace or repair stolen vehicles. According to the RCMP, car thieves sometimes sell vehicles abroad with the vehicle identification number (VIN) intact, sold for more than their original market value. Domestically, thieves install false VINs and sell stolen vehicles to unsuspecting consumers. Or, they're sold for parts, while some are stolen for a “joyride” or to commit another crime.
6. Claiming Old Injuries are New Injuries
Attempts to fraudulently claim pre-existing injuries so as to receive money or benefits covered by insurance policies. Injuries sustained prior to the time and date the policy came into effect, such as broken limbs, spinal injuries, disabilities, etc. are claimed as having occured during the incident, accident, or illness.
Insurance Fraud Information and Resources
How are Canadians affected by insurance fraud?
The Insurance Bureau of Canada estimates that insurance fraud costs Canadian taxpayers over $2 billion dollars annually. Fraudulent claims stress Canada’s health care system, drain resources from emergency services such as police, and places a burden on court systems. The end results for Canadians are higher taxes and insurance premium costs.
- Insurance premiums are increased due to losses sustained by the insurers. Significant losses could lead to company-wide insurance rates increases.
- The healthcare system must bare the cost of assessing and even treating people who don't actually need medical care. This results in longer wait times for services, increased response times for ambulance and emergency services, not to mention higer taxes to pay for all of this.
- Fraud court cases can be time consuming and expensive - Canadian court costs for cases, appeals, and lawsuits burden the average taxpayer. Not to mention, successful fraudsters are rewarded when their lawyers win cases!
What are the types of insurance investigators?
- fraud examiner
- forensic analyst
- forensic engineer
- fire investigator
- field investigator
- forensic accountant
- special investigator
- corporate claims analyst
- independent investigator
- car insurance investigator
- construction claims analyst
- insurance claims investigator
- car insurance fraud investigator
- life insurance fraud investigator
- auto insurance fraud investigator
- health insurance fraud investigator
- insurance fraud claims investigator
- dental insurance fraud investigator
- insurance fraud private investigator
- medical insurance fraud investigator
Canadian documented examples of insurance benefits fraud?
- In 2018, 250 employees were terminated by the TTC (Toronto Transit Commission) for involvement in orthotics claim scams.
- A firefighter in Toronto was imprisoned for 6 months for $32,000 worth of forged medical receipt claims.
- A York University professor was said to have been terminated, appealed it, and lost for apparently $8,000 worth of massage and physiotherapy false claims.
Canadian Life & Health Insurance stats?
The CLHIA (Canadian Life and Health Insurance Association) estimated in 2018 that 2-10% of reported insurance claims are fraudulent. This resulted in between $600 million - $3.4 billion of annual theft of 2018.
Common methods criminals use to steal health and life benefits medical insurance information?
- “Free screening” scams
- Fake companies “selling” patient data on the black market
- “Bribing” medical staff to provide patient insurance data for the purposes of committing insurance fraud
- “Add value” bonuses and incentives, such as money or gifts, for beneficiaries to visit a medical clinic
Canadian Auto Insurance stats?
According to the Insurance Bureau of Canada:
- In 2019, Canadian private P&C (Property and Casualty) insurers paid over $20.3 billion in claims for auto insurance coverage. This includes 3rd-party liability, accident benefits, collision and comprehensive, and others.
- 83.5% of claims were for private passenger vehicle accidents.
- 47.1% of payouts went to third-party liability claims.
Canadian insurance fraud related resources:
Canadian Security Intelligence Services