The Role of Investigators in Fraudulent Insurance Claims

Updated on September 8, 2024.

In Canada, insurance fraud is a greater issue than we might think, and perpetrators are becoming increasingly inventive. 
Gone are the days of simply filing a fraudulent claim for supposedly lost jewelry. Instead, a driver in front of you might stop quickly to cause an accident and pretend to be hurt. Or someone might create a fake title or registration for an expensive antique car that doesn’t exist, then declare the vehicle stolen to file a claim.

In fact, fraudulent claims cost the insurance industry billions of dollars a year, and early detection has become crucial for insurers. While it can be difficult for claims workers to keep an eye out for unusual conduct that could point to a potential fraud, fortunately, there is always something that gives fraudsters away.

How to identify patterns of fraud

Fraud is sometimes fairly easy to spot when a scammer submits multiple questionable claims to a single insurance provider. That’s why perpetrators frequently target several different insurance providers, which allows them to avoid being spotted by an insurer’s own detection system.

Additionally, insurers look for any patterns in the frequency and type of prior claims. They keep extensive records on claims and use a variety of analyses to understand the data, from identifying who is most likely to file a claim to determining when and where. They will notice if your claim deviates from the usual trends.

What is the role of an investigator?

Here is where our investigators come in handy. They employ different strategies to detect fraud, such as conducting background investigations, reviewing criminal records, speaking directly with them and with witnesses, and visiting locations relevant to the event.

The investigative team will initially determine if there is tangible proof of financial fraud. Pertinent records are obtained and examined, the nature of the scheme is investigated, and the extend of the financial loss is reported. Specific controls and countermeasures can be suggested if the scam is ongoing to protect the customer from the possibility of further losses.

Once the nature and extent of the scam is exposed and major pieces of the financial puzzle are mapped out, the investigative team will focus its efforts on positively identifying the responsible parties.

If appropriate, investigators will conduct interviews with potential suspects and witnesses. They will also examine statements for consistency. Most importantly, they will dig deeper into the stories and evaluate them to determine if the details are consistent or if, instead, they are conflicting or contradictory. Everything is examined in light of the evidence obtained through an independent investigation, including considerations of motive, means and opportunity. The final step in the process is to obtain a confession from the prime suspect.

Of course, this is only a small sample of the many steps our investigators take. Sometimes, large-scale investigations can go on for months or years and involve parties in different locations. That’s one of the advantages of working with an organization that has teams across the globe, which is the case at GardaWorld.

Want to learn more because you think you need the services of GardaWorld’s investigators? Visit our service page.