Insurance Fraud: How It Happens and What You Can Do About It

Fraudulent claims are a growing problem that affects both consumers and companies. FBI estimates it costs over $40 billion annually, excluding health insurance fraud. Insurance fraud can occur in many ways, and it is essential that you understand how it occurs and how to protect yourself.

The act of deceiving an insurance company with the intent of obtaining financial gain is known as insurance fraud. This can occur during the purchase of a policy, when submitting a claim, or when underwriting the policy. An insurance professional can commit fraud, as well as policyholders and third-party claimants.

Insurance Fraud Types

Soft Fraud: Exaggerating or embellishing legitimate claims, such as inflated repair costs following an accident.

A fraudulent act : Staged or faked accidents or incidents.

Admin fraud : The manipulation of employee claims or policies in order to benefit the employee.

Identity Fraud: The act of using a person's identity in order to receive insurance coverage or to file a claim.

Insurance Fraud: How it Happens

1. Staged accidents

The purpose of insurance fraud is causing accidents to file exaggerated claims. A fake witness or a fake medical professional often supports the claim.

Example: A driver abruptly stops, causing a rear-end collision, and falsely claims severe injuries.

2. Claims that are fraudulent

Fraudulent claims are those that overstate losses or claim damages that don't exist.

Example: A homeowner claims a high-value item was stolen, even though it never existed.

3. Fraud in healthcare

The practice involves billing for services not provided, falsifying diagnoses, or performing unnecessary procedures.

Example: A provider bills for more costly procedures than they performed, or for treatments he didn't administer.

4. Fraud by agents and brokers

There are cases where agents pocket premiums or sell fake policies that result in uninsured policyholders.

Example: An insurance broker collects premiums without creating a policy and keeps them.

5. Insurance fraud

One example is faking your death or murdering someone to get insurance money.

Example: A person stages their own death and receives insurance payouts from an accomplice.

Fraudulent Insurance Policies: How to Avoid Them

1. Ensure that the information is accurate and reliable

Company Research: Ensure that the company is legitimate and licensed.

Credentials: Make sure your agent is licensed and in good standing with the state department of insurance.

2. Review policies carefully

Become familiar with your policy's terms and details. Feel free to ask questions if you are unsure.

Be sure to keep records: Keep records of all communications and documents related to your insurance policies.

3. Tracking billings and claims

Review Bills: Always review your statements to identify any unauthorized charges.

Offers that seem too good to be true should be avoided.

4. Submit a Fraud Report

Authorities: Contact your insurance company's fraud department or local law enforcement if you suspect suspicious activity.

Hotlines : Insurance fraud can be reported anonymously through many state hotlines.

5. Become educated

Educate yourself: Be aware of common fraud schemes and tactics.

Invest in seminars: Attend fraud prevention workshops and seminars whenever possible.

As a result of insurance fraud, premiums rise and coverage options are reduced. Understanding fraud and taking preventative measures can help combat it. Stay informed, vigilant, and ensure the money you spend goes towards legitimate coverage. Consult an experienced professional if you are ever unsure.

Please note that the information provided in this article is intended for general informational purposes only and may not apply to your specific situation. Insurance laws and regulations can vary significantly from state to state, and it’s crucial to understand the specific requirements and coverages that apply to your location. We strongly recommend consulting with a licensed insurance agent in your state to discuss your unique needs and ensure you have the appropriate coverage for your circumstances.

< Older Post

Newer Post >

Oklahoma Contractors' Guide to Compliance and Protection: Essential Insurance and Bonds

By Steven Conway • December 29, 2024

Oklahoma contractors must be insured and bonded in order to maintain legal compliance, financial protection, and client trust. Oklahoma Industry Board requires licensed contractors to carry certain insurance policies and bonds. Besides these essentials, you can also protect your business and reputation with additional types of coverage. Contractors in Oklahoma are required to carry insurance For contractors to operate legally and protect their clients, employees, and business assets, Oklahoma law requires them to carry specific types of insurance. Oklahoma Industry Board mandates the following insurance policies: 1 . Liability insurance All contractors in Oklahoma must carry general liability insurance. The policy covers injuries, property damage, and legal expenses resulting from accidents on the job. In the event that contractors cause harm to someone or damage property during the course of their work, this policy covers them. 2. Compensation insurance for workers Workers' compensation insurance must be carried by contractors with employees. If an employee is injured or ill at work, this insurance will cover medical benefits and wage replacement. Fines and legal consequences can result from failing to carry workers' compensation insurance. 3. Insurance for vehicles Automobile insurance is required if you or your employees use vehicles for business purposes, such as transporting materials. You must have this coverage to protect your vehicles from accidents and to ensure that any third-party property damage or injury is covered. Contractors may wish to carry additional insurance To ensure comprehensive coverage, licensed contractors should consider several additional types of insurance policies in addition to those mandated by the Oklahoma Industry Board. Included are: 1. Professional Liability Insurance Consultants, engineers, and designers need errors and omissions insurance to protect themselves. In the event of errors, omissions, or professional negligence, your work is protected. 2. Insurance for commercial property In order to protect your business assets, such as office space, tools, equipment, and inventory, you must purchase commercial property insurance. If your property is damaged by fire, theft, or natural disaster, you will be covered. 3. Insurance for builders' risks Builder's risk insurance covers construction projects in progress. Damage to the structure during construction caused by fire, vandalism, or weather-related events is covered by this policy. 4. Insurance for equipment and tools Contractors need coverage in case their tools and equipment are damaged, lost, or stolen. In the event of an unexpected event, equipment and tool insurance will minimize downtime and financial loss. Oklahoma Contractors' Mandatory Bonds Oklahoma contractors are often required to have bonds in addition to insurance. These bonds may either be mandatory by the State of Oklahoma or contractor’s client and contract, or both. Bonds ensure compliance with state regulations and contractual obligations by the contractor and compliance. Type of Bonds: 1. Contractor's license bond A contractor's license bond is required by the state as part of the licensing process. The bond ensures that contractors abide by Oklahoma's building codes, regulations, and laws. When a contractor fails to meet their obligations or causes harm in the course of their work, it provides a safeguard for clients. 2. Bond for performance Performance bonds are often required from contractors for large and public projects. In addition, it ensures the contractor will complete the work on time and in accordance with the contract. As a result of this bond, the client is guaranteed compensation if the contractor fails to meet these requirements. 3. Payment Bond A payment bond ensures that subcontractors and suppliers are paid for their work on public projects. This prevents contractors from being held liable for any unpaid bills or liens placed against the project due to unpaid debts. 4. Supply Bond A supply bond ensures that contractors will provide all necessary materials for a project. In the event that the contractor fails to deliver the necessary supplies or fails to meet their contractual obligations, this bond protects owners and developers. 5. Local Bonds Ensure the contractor abides by local regulations and obtains all necessary permits. 6. Bid Bonds A bid bond is issued as part of a supply bidding process by the contractor to the project owner, to provide guarantee, that the winning bidder will undertake the contract under the terms at which they bid. The bond penalty is subject to full or partial forfeiture if the winning contractor fails to either execute the contract or provide the required performance and/or payment bonds. Contractors in Oklahoma must not only comply with state-mandated insurance and bonding requirements to operate legally but also contractually. For additional protection, contractors should also consider additional policies and bonds in addition to those recommended by the Oklahoma Industry Board and/or by contract. The right insurance and bonding are crucial to minimizing risk, regardless of how long you've been in business. Please note that the information provided in this article is intended for general informational purposes only and may not apply to your specific situation. Insurance laws and regulations can vary significantly from state to state, and it’s crucial to understand the specific requirements and coverages that apply to your location. We strongly recommend consulting with a licensed insurance agent in your state to discuss your unique needs and ensure you have the appropriate coverage for your circumstances.

Feel the Wind and Freedom of owning a Motorcycle

By Steven Conway • December 15, 2024

A motorcycle insured in Oklahoma must be kept in good working order to avoid accidents Oklahoma motorcycle riding can be thrilling and rewarding, but it is not without risk. It is easy to get caught up in the state's wide-open roads and scenic routes when you take a ride along them. A good motorcycle insurance policy, proper maintenance, and safe riding can reduce your chances of getting into accidents and financial burdens. Safety and insurance for motorcycles The ability to protect you in the event of an accident is an important feature of motorcycle insurance. According to the Oklahoma Highway Safety Office, nearly 60% of motorcycle crashes resulted in injury or death. A motorcycle accident is 29 times more likely to result in death than a road accident involving a passenger vehicle, according to the National Highway Traffic Safety Administration. It is imperative that proper safety precautions be taken considering statistics like these. One should always wear a helmet. It is not just a good idea for safety but is also required by law in Oklahoma and most States of the United State if not all of them. It is always a good idea to choose one with a good safety rating. Other safety apparel should not be neglected either. A motorcycle rider should consider clothing and gear that reduces road rash, impact protection to minimize broken bones and internal injuries, increases visibility, and weather protection. Don't speed or drive recklessly: Speeding and reckless driving increases your chances of getting into an accident. To stay safe, follow all road rules. Motorcycle Maintenance: Preventing Mechanical Failures Maintaining your motorcycle properly is essential to avoiding mechanical failure-related accidents. Focus on these things: • Make sure that your tires are properly inflated and treaded to prevent slipping and blowouts. The front and rear brakes should be inspected for wear. A brake pad should be replaced when it begins to thin. • Check that your headlights, taillights, and turn signals are working properly, especially at night. • Ensure smooth and safe operation by regularly checking oil levels, engine coolant, and brake fluid. Maintenance, especially before and after long trips, can prevent accidents caused by avoidable breakdowns and mechanical failures. How Motorcycle Insurance Protects You Just like an automobile owner, motorcycle owners are required to carry a minimum amount of liability coverage, but this is often insufficient to cover the costs associated with motorcycle accidents. A motorcycle accident can cause a great deal of damage and if you have just state minimum liability insurance, you may be covering damage not just to your motorcycle out of your own pocket but also any injuries you sustain. It is estimated that a motorcycle accident can result in a significant amount of bodily injury. U.S. motorcycle bodily injury claims average more than $25,000, according to the Insurance Information Institute (III). Damages to your motorcycle or property are not included in this calculation. Having adequate insurance can protect you financially if the unexpected happens. Here are some types of motorcycle insurance you should consider : • Liability Insurance: Covers you if you damage property or cause injury to someone else. • Comprehensive and Collision Insurance: These cover damages to your motorcycle in event of an accident (regardless of fault), theft, hail damage, and other perils. • Uninsured/Underinsured Motorist Insurance: Covers injuries and other bodily injury damages you incur if you are hit by an uninsured or underinsured driver and the other driver is at fault. • Medical Payment: Covers medical payments in event of an accident regardless of fault. Invest in the right coverage Motorcycle accidents are more common than many people realize, and their consequences can be severe. Maintaining your bike, having the right insurance coverage, and practicing safe riding habits are all key steps in protecting yourself on the road. Invest in comprehensive coverage today to enjoy peace of mind on every ride. Please note that the information provided in this article is intended for general informational purposes only and may not apply to your specific situation. Insurance laws and regulations can vary significantly from state to state, and it’s crucial to understand the specific requirements and coverages that apply to your location. We strongly recommend consulting with a licensed insurance agent in your state to discuss your unique needs and ensure you have the appropriate coverage for your circumstances.