Fraud happens any time someone purposefully lies to obtain some benefit or advantage to which they are not otherwise eligible or a person knowingly denies some gain that is due and to which someone is entitled. With regards to the particular issues involved, an alleged wrongful act may be treated as an administrative action by the Section or the Scam Division could handle it as a criminal matter. California and federal laws additionally permit the Fraud Division to go after its cases federally. In these occasions, the crime of “insurance scam” is generally pursued as “mail fraud,” “felony racketeering” or other federal crimes.
The bad economy is producing a bumper crop of cash-strapped consumers, business owners and shady brokers who are encouraging a wave of insurance fraud that’s keeping government bodies and law enforcement officials busy from coast to coast. Whether it’s worthless health programs peddled via fax, staged auto accidents, arson or slip-and-fall incidents in the local mall, insurance scam of all types is booming in the economic downturn and consumers are paying the price in higher monthly premiums. To keep this in perspective, roughly forty eight million insurance statements are prepared every year within the U.S. and less than one-quarter of one % are referred to the nonprofit National Insurance Crime Bureau for exploration of probable fraud.
Watch out – insurance crooks are picking your wallet in order to line their own. These thieves are committing insurance scam, one of the country’s largest criminal industries. Insurance fraudulence is a crime, and one way or another, honest consumers and organizations pay the price. One example is medical health insurance fraud. With this type of fraud’ false or deceptive information is provided to a health insurance organization so as to have them pay out unauthorized benefits to the policy holder’ another party’ or the organization offering services. The offense can be committed by the covered individual or the supplier of health companies.
Fraud may be committed at different points within the insurance deal by various parties: applicants for insurance coverage, customers, third-party claimants as well as experts who offer services to claimants. Common frauds include “padding,” or inflating actual claims; misrepresenting details on an insurance application; submitting claims for injuries or damage that never occurred; and “staging” accidents. Is it possible that a single motivation for insurance scam is to get back at insurance companies that provide poor service? Based on the survey results, fifty five % of American consumers say poor service coming from an insurance company is more prone to cause a person to commit deception against the company.
The “chief motive in all insurance crimes is financial profit.” Insurance contracts provide the insured and the insurer with opportunities for exploitation. One reason that this particular opportunity arises is in the case of excessive-insurance, when the amount covered is greater than the actual valuation of the property covered. This problem could be very difficult to avoid, specifically since an insurance provider might occasionally promote it to be able to obtain greater earnings. This allows fraudsters to make profits by destroying their property since the payment they will get from their insurance companies is of greater value as opposed to the property they destroy.