What To Do If You Are Accused Of Insurance Fraud PDF Print E-mail
Written by Graham McKenzie   
Saturday, 15 May 2010 15:01
A major problem that insurance companies face is insurance fraud. This area of fraud has many different types, all of which can prove to be extremely expensive to insurance companies and policy holders. Because of this, insurance companies devote whole departments to seeking out and verifying insurance fraud. This process may sound startling to some, but it is a sure-fire way to catch fraud, effectively decreasing costs for both companies and their policy holders.
by GrahamMcKenzie


A major problem that insurance companies face is insurance fraud. This area of fraud has many different types, all of which can prove to be extremely expensive to insurance companies and policy holders. Because of this, insurance companies devote whole departments to seeking out and verifying insurance fraud. This process may sound startling to some, but it is a sure-fire way to catch fraud, effectively decreasing costs for both companies and their policy holders.

Fraud in the insurance domain is a serious offense. There are different types of violations that get encompassed under this category. All those entities which require insurance, namely medical, home, personal injury, car collision, and personal articles, are all susceptible of being cheated. The occurring form of insurance fraud can be anything from falsified claims, falsified documents and procedures, exaggerated claims, etc. Once the insurance fraud gets proven in the court, the guilty party will have to remit the money back to the victims as well as face a felony charge on their record. The severity of the fraud will decide the duration of a prison term for the violator.

If you have gotten word from your insurance company that they suspect fraud, the first thing you need to do is find out the details of the fraud charges that have been brought against you. There are a few different ways that you can approach getting that information. You can choose to deal directly with the insurance company to get the information, or you can choose to retain an attorney to get the information for you.

There are advantages and disadvantages to both ways. If you hire an attorney, the insurance company may take a closer look at their charges against you and make sure that they feel confident that they can make a lawful claim in court; however, hiring an attorney can get to be very expensive, and if the claim is a basic misunderstanding, you might waste money by hiring an attorney.

You can decide to deal with this on your own. This is, of course, the cheaper option. However, if the insurance company does have a good, strong case against you, you might find you have bitten off more than you can chew and need a lawyer. Some misunderstandings, those requiring filing paperwork or a quick visit to the doctor, are things that can be dealt with on your own without legal counsel. If things get worse quickly, or it seems that the insurance company is intent on prosecuting your case, it might be a good idea to retain a lawyer.

When the charges are presented against you, a decision needs to be made on whether you will be enlisting the help of an attorney or representing yourself. Some things to consider: if it is a misunderstanding, the strength of the claim, the need for documents or testimonials as evidence, and the time it will take to resolve the matter.

Make every reasonable effort to resolve the issue as quickly and efficiently as is within your power. Give serious consideration to resolving the situation outside of the court system if it appears possible. However, if the insurance company appears unwilling to negotiate (or unwilling to even give you a listen) or you feel you?ve been falsely accused, it may be advisable to present your case in court with an attorney?s assistance.

DISCLAIMER: This article is provided as information only and is not to be taken as financial advice.

Graham McKenzie is the syndication coordinator a leading South African Insurance information portal, which amongst others specialises in Car Insurance.