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Insurance Investigations

The National Insurance Crime Bureau (NICB) reports that after tax evasion, fraud is the most costly white-collar crime in the United States. It's not only costly to insurance companies and businesses, but a portion of the costs are passed along to consumers. NICB estimates that at least 10 percent of all property and casualty insurance claims are filed incorrectly with intent to defraud. Who commits insurance fraud?

  • Unscrupulous repair shops, contractors, and individuals

  • Dishonest attorneys, physicians, chiropractors, dentists, and other professionals

  • Organized rings dedicated to sophisticated, large-scale fraud

  • Individuals who add to or pad their claims

  • National Insurance Fraud Investigators (www.nafraud.com) was organized to serve a broad membership — insurance companies, law enforcement and bond enforcement officers, information services, forensic examiners, skip tracers, investigators, security specialists, and attorneys — in the United States and abroad. Membership includes access to networking opportunities, education and training, and a newsletter filled with up-to-date information on fraud investigations.

    Insurance Overview

    Insurance is a contract between the insured, who agrees to pay for services, and the insurer, who agrees to provide monetary reimbursement for certain losses that may be incurred by the insured. There are two very wide categories of insurance: government insurance and private insurance, each divided into industries. Government insurance can be divided into compulsory and voluntary, while private insurance is usually divided into four sectors: casualty, fire, life, and marine.

    Government Compulsory Insurance can be:

  • Unemployment benefits

  • Social Security benefits

  • Workers' compensation in many states

  • Government Voluntary Insurance examples:

  • Savings and loans and bank depositor insurance

  • Federal crop insurance

  • Military personnel insurance

  • Flood insurance

  • Private insurance is voluntary, except for the compulsory (basic collision) automobile insurance required on all drivers in most states. There are many types of private insurance, but some of the basic types are listed below.

    Basic Types of Private Insurance

  • Life

  • Home

  • Rental

  • Automobile

  • Health and medical

  • Specialty insurance

  • It's important to be familiar with appropriate terms in order to work in the insurance industry. Knowing something of the most used terms will also help you when interviewing for a position investigating insurance fraud. Several Web sites offer glossaries of terms related to the industry. Some are:

  • AM Best: www.ambest.com/resource/glossary.html

  • Glossarist: www.glossarist.com/glossaries/economy-finance/insurance.asp

  • Insurance Information Institute: www.iii.org/media/glossary

  • Hanover Insurance Group: www.hanover.com/thg/tools/glossary.htm

  • Trafalgar International LTD: www.trafalgar-intl.com/definitions.htm

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