Insurance SIU Investigations
Every insurance company has a special investigative unit to investigate suspicious insurance claims. Depending on the insurance claim, your case may be referred to SIU for potential fraud. While SIU, special investigative unit, handles a lot of queries, it does not mean that every insurance claim that goes to the department is fraudulent.
Well-known insurance companies follow a strict policy of checking certain types of insurance claims by sending it to SIU. After checking for discrepancies, the department can refer back the case to the insurance officer for normal processing; however, most cases referred to SIU are referred to check for potential fraud.
How Does SIU Operate?
The unit comprises of special investigators who have a law enforcement background and a lot of experience in handling insurance policies. The main goal of the department is to detect and prevent insurance claims. Property damage, arson claims, and dubious car accidents are some of the most prevalent fraudulent claims that are addressed by SIU.
SIU adjusters closely collaborate with local law enforcement agencies, FBI, and National Insurance Crime Bureau. These agencies are also responsible for educating and training SIU agents to handle insurance frauds.
Whenever the adjuster uncovers evidence of fraud, the case is sent to the agencies for criminal investigations. In the case of wrongdoing, the agencies, in collaboration with the insurance company files a lawsuit against the perpetrator based on the evidence gathered by SIU.
Examples of SIU Insurance Cases
Insurance SIU investigations mostly handle claims pertaining to possible staged car accidents, arson claims, and suspect medical treatments. To combat fraud, an insurance company require services of experienced insurance adjusters as criminal organizations and hardened criminals are involved in generating false claims.
For instance, it's common for criminals to stage car accidents by hitting an innocent driver. In this particular scenario, four of five passengers may claim fake injuries due to the accident. With the help of a doctor, these gangs often show soft tissue injuries, which are difficult to refute by the insurance company. Instead of filing a costly lawsuit against such perpetrators, the insurance company pays them the claim, which costs less than the lawsuit.
Similarly, building fires and property damages are also susceptible to massive insurance frauds that can run into millions of dollars. Sometimes, it's easier for criminals to claim thousands of dollars in property damage by exaggerating the cost of the furniture and other valuables destroyed by fire. Since it is difficult to evaluate the true value of damaged furniture, appliances, and other records destroyed by fire, SIU is the only source that insurance companies can look for help.
Another widely prevalent fraud is medical claims. Many individuals fake the medical history of their dependents when buying an insurance policy. Often, it is easy to hide medical problems, injuries, and symptoms if a medical history does not exist. In such cases, it's almost difficult for an average insurance agent to investigate the issue; hence, the case is referred to the special investigation unit.
These examples clearly demonstrate that insurance companies require knowledgeable individuals who can help detect insurance fraud. It should be noticed that any case sent to SIU will cost the insurance company as agents diligently do background checks and surveillance, if necessary.
These procedures are sometimes very expansive; therefore, only specific cases are sent to the SIU. In fact, some insurance companies will only send the case to the department if it feels that there is a strong chance of potential fraud.
What Happens After the Case is Sent to SIU?
Once the case is transferred to SIU, detailed investigation process begins, which is similar to investigations carried out by law enforcement agencies.
It means that you can be asked to give an oath in front of the court reporter. It also means that you may need to provide a medical checkup. Don't be surprised if you find that you are under constant surveillance by law enforcement authorities.
The second step involves questioning by law officers including teams from FBI, who will like to uncover all the details regarding the claim and any history associated with it. You may be required to contact the local police station for formal investigations. Officers from the National Insurance Crime Bureau, Police, and FBI will try to prove or disprove a fraud, where applicable.
Private investigators from the SIU team investigate every lead to understand the nature of the claim. The process may take a lot of time depending on the complexity and conditions leading to the accident.
Insurance officers will only pass insurance claim to SIU if they feel that there is a genuine case of fraud. In certain cases, where the stakes are in Millions of dollars, the case is automatically transferred to the SIU to verify that there is no wrongdoing on part of the claimant.
iovation is a leading provider of fraud protection services as well as advanced MFA software for online banking, e-commerce, insurance, online casino gambling, online communities, and travel and ticketing organizations.
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