File Review

Highly skilled and experienced claims investigators review case files for indicators or "red flags" which may suggest fraud. When three or more of the following indicators are present in a file, serious consideration should be given to consulting with FARA Security Services, Inc. to determine if investigation is warranted:

Attitude

• Claimant is wanting a quick settlement and threatens to retain an attorney or file a complaint with the insurance commissioner.
• Claimant is well versed in insurance procedures and/or medical terminology.
• He/she forgets key details except for when the claim was filed and the amount of payment expected.
• Frequently calls the adjuster and his/her supervisor regarding the status of the claim.
• Tendency to be hostile when asked for documentation and/or is unwilling to provide an authorization for the release of information.
• Claimant will not give a recorded or written statement.
• May have worked for an insurance company or have been in law enforcement.

Worker's Compensation

• The report of the injury/accident is not made immediately.
• Injury/accident is not witnessed.
• Accident is reported in an area that the claimant has no legitimate reason to be in.
• Individual cannot recall details of the accident.
• Witness statements and statement of the claimant differ.
• Claim reported prior to the claimant being laid off or fired.
• Claim reported after the individual has been fired.
• Injury/accident occurs on a Monday morning of a Friday.
• Other employees have heard that the claim was not legitimate.

Bodily Injury

• Loss occurred within two months of policy taking effect.
• "Unknown" hit and run vehicle cause of accident.
• Rear-end collision caused due to sudden stop for no apparent reason.
• No police report
• No witnesses to the accident or unbelievable witness.
• Claimant has no I.D., out-of-state I.D., or temporary I.D.
• Claimant will only provide a P.O. Box or temporary relative's address.
• Claimant's telephone number belongs to a relative, friend or answering service, cellular phone or pager.
• Claimant was driving a rental vehicle at the time of reported accident.
• Claimant's vehicle was uninsured or an older model with existing damage.
• There is minor or no apparent damage to vehicles involved in claimed accident.
• There are multiple claimants in either vehicle.
• The claimants in vehicle are unrelated.
• Injuries are soft tissue and/or subjective.
• Claimant presses for quick settlement and is agreeable to a lesser value if settlement is quick.
• Claimant did not request or seek treatment or complain at the time of the accident.

Call 800-215-3272 ext. 302 * Fax 337-235-4153 attn. Christopher Will
Email christopher.will@fara.com