NCJ Number
66748
Date Published
1979
Length
40 pages
Annotation
THIS HANDBOOK ACQUAINTS INSURANCE PERSONNEL WITH THE MAJOR TYPES OF INSURANCE FRAUD SCHEMES AND THE SUSPICIOUS CIRCUMSTANCES SURROUNDING FRAUDULENT CLAIMS.
Abstract
DISCUSSION OF AUTOMOBILE PROPERTY FRAUDS ENCOMPASS SUCH VARIANTS AS THE STAGED ACCIDENT RACKET, THE INFLATED DAMAGE DODGE, THE STOLEN CAR SWITCH, AND THE 'PAPER GAME,' WHICH INVOLVES REPORTING ACCIDENTS THAT NEVER TOOK PLACE. RELATED TO THESE ARE AUTOMOBILE BODILY INJURY FRAUDS INCLUDING CLAIMANT SWINDLES AND DOCTOR-LAWYER CONSPIRACIES. ANOTHER INSURANCE FRAUD CATEGORY, ARSON FOR PROFIT, MAY INVOLVE SMALL BUSINESS ARSON, HOME FIRES, OR ARSON-FOR-PROFIT RINGS OPERATING IN RUNDOWN URBAN DISTRICTS. ALSO EXAMINED ARE PROPERTY FRAUDS SUCH AS THE CONTRACTOR'S RIP-OFF, THE MYSTERIOUS BOAT DISAPPEARANCE, THE LOST BAGGAGE TRICK, THE PHONY PROPERTY THEFT, AND THE FAKE BUSINESS BURGLARY. DISCUSSION ALSO PERTAINS TO OTHER FRAUDS, CALLED MEDICAL SPECIALS FRAUDS, WHICH ARE ILLUSTRATED BY THE SLIP AND FALL SCAM, THE PRODUCT LIABILITY CON, AND THE INFLATED BILLING SCHEME. EACH TYPE OF FRAUD IS INTRODUCED BY A TYPICAL CASE DESCRIPTION AND THEN EXPLAINED IN TERMS OF THE RATIONALE AND ACTIONS INVOLVED IN PERPETRATING IT. THE CHARACTERISTIC CIRCUMSTANCES WARRANTING CLOSER SCRUTINY ARE THEN OUTLINED, AND SUSPICIOUS FEATURES OF THE CLAIMS DOCUMENTATION ENUMERATED. A FINAL CHAPTER SUMMARIZES THE STEPS INSURANCE PERSONNEL SHOULD FOLLOW WHEN HANDLING SUSPICIOUS CLAIMS. TO CONSTITUTE A CASE, THE INVESTIGATIVE PROCEDURE MUST ESTABLISH PROOF OF FRAUD, PROOF OR RELIANCE UPON FALSIFIED DOCUMENTATION, AND PROOF OF IDENTITY THAT THE PERSON TO BE CHARGED IS THE ONE WHO COMMITTED THE CRIME. ILLUSTRATIONS ARE INCLUDED. (MRK)