insurance fraud

Why is my Insurance Claim Being Investigated?

What is Insurance Fraud?

Insurance fraud is an attempt to deceive an insurer: for example, when an insured lies on a policy application or fabricates a claim for financial gain. There must be an intent to defraud in order to be charged and convicted of insurance fraud. If a person provides inaccurate or incorrect information on an insurance claim because the person was confused or mistaken, then there is no intent to defraud and hence no insurance fraud.

If an insurance investigator wants to speak with you about your claim, it does not necessarily mean you are being investigated for fraud. There are several reasons why an investigator may want to discuss your claim:

  • Routine Procedure: Insurance companies often conduct routine checks to verify the details of claims. This helps them ensure that claims are legitimate and comply with their policies.
  • Clarification: The investigator may simply need more information or clarification about specific aspects of your claim. This can be part of the normal process of claim verification.
  • Discrepancies or Concerns: If there are discrepancies or unusual patterns in your claim or claims history, the investigator may want to discuss these. This is to understand the situation better, not necessarily to accuse you of fraud.
  • Further Investigation: Insurance companies often conduct claim investigations because they suspect fraud.

Suspected of Insurance Fraud?

While it is understandable to be concerned if an insurance investigator wants to speak with you about your claim, it is important not to jump to conclusions about their intentions. Here are some steps you should consider:

  • Understand the Seriousness: Recognize that insurance fraud is a serious matter. It can lead to criminal charges, fines, and even imprisonment. The fact that an investigator is involved suggests that the insurance company has concerns about your claim.
  • Do Not Panic: Stay calm and collected. Panicking can lead to poor decisions.
  • Seek Clarification: Do not hesitate to ask the investigator why they want to talk with you and what specific information they need.
  • Avoid Making Statements Immediately: It is generally advisable not to discuss the case with the investigator until you have legal representation.
  • Consult an Attorney: If you have concerns about the nature of the inquiry or feel uncertain, and suspect that the inquiry may be unusual, then end the interview politely and immediately contact a criminal defense lawyer with experience in insurance fraud matters. Tell the investigator you will get back to him within 48 hours.
  • Do Not Provide Additional Documentation Without Legal Advice: Wait for your attorney’s advice before submitting any additional information to the insurance company or the investigator.
  • Review Your Claim: Go over your claim with your attorney to identify areas that might be problematic. Be honest with your attorney about all aspects of your claim.
  • Understand the Possible Outcomes: Depending on the situation, there could be various outcomes, including the denial of your claim, a demand for repayment of any funds already disbursed, criminal charges brought against you, or a settlement.
  • Be Prepared for the Investigative Process: The investigator will likely conduct a background search on the claimant to identify previous fraudulent activities or criminal history; review bank statements; phone records; video surveillance; witness statements; social media profiles, and online activities. Your attorney will help you prepare for any interviews or requests for information.
  • Consider the Possibility of Rectifying the Situation: In some cases, it might be possible to rectify the situation, such as by amending the claim or repaying any overpaid amounts. Your attorney will advise you on whether this is a viable option.
  • Stay Informed and Involved: Keep in contact with your attorney and stay informed about the progress of your case. Make sure you understand each step of the process and the implications of any decisions you make.

Insurance Fraud Defense Attorneys

If you suspect you are being investigated for insurance fraud, contact us today at 213-482-6811 and learn how we can assist you. We have the skills and experience to handle your case. Be proactive. Early intervention of a fraud investigation is critical. As experienced lawyers, we may be able to prevent criminal charges from being filed against you.

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