Fraudulent Slip and Fall Insurance Claim

Contemplating filing a Fraudulent Slip and Fall Insurance Claim?  Think again!

An alleged fraudulent slip and fall insurance claim scheme has been exposed in Philadelphia.

Philadelphia District Attorney Seth Williams recently announced that Forty-six people are being charged in connection with a wide-ranging fraudulent slip and fall insurance claim scheme in Philadelphia. A Philadelphia lawyer orchestrated the fraudulent slip and fall insurance claim scheme, which allegedly swindled 21 insurance companies out of nearly $400,000. According to a grand jury presentment, a Philadelphia lawyer paid “runners” to recruit people to stage phony slip-and-fall accidents so he could file false insurance claims. The conspirators were carefully trained to lie to paramedics and doctors in order to generate paperwork documenting the falls.

“Insurance fraud is not a victim-less crime.  False claims cause all of us to pay higher insurance rates. Insurance fraud ties up fire and rescue personnel and resources that should be assisting true emergency victims.”

District Attorney Williams stated that 15 defendants already have pleaded guilty, four were allowed into diversionary programs and three have scheduled guilty pleas. His office is working to track down the remaining 24 defendants.

Making a fraudulent slip and fall claim is illegal, and the penalties are severe.  Make no mistake that you will likely be discovered if you do make the terrible decision of filing a fraudulent slip and fall claim.   Below are some things you should know about a fraudulent slip and fall insurance claim.

“While many people have legitimate accidents in stores and businesses across the country, we’ve seen a growing number of cases that have some indication of potential fraud,” said Joe Wehrle, NICB president and chief executive officer. “Our agents, working with insurance company investigators and law enforcement, are busy identifying and targeting organized criminal rings that make a good living staging slip and fall accidents.  They come into an area and hit several retailers, grocers, or other businesses with sophisticated schemes and professional execution. They hope to collect a quick payout and move on before anyone realizes what’s going on.  Fortunately, we’ve worked with insurers to raise the awareness level and urged companies to analyze claims before they pay.”

What is a Fraudulent Slip and Fall Insurance Claim?

Swindlers will pretend to slip or trip and injure themselves to fraudulently collect insurance settlements or other payouts. Often the swindlers threaten an expensive lawsuit to extort fast payouts. Businesses are frequent targets.

What percentage of Slip and Fall Claims are Fraudulent?

Three percent of slip-and-fall injuries are fraudulent. (National Floor Safety Institute)

How much did fraudulent Slip and Fall Insurance Claims cost last year?

Bogus injury claims and related costs such as litigation amount to nearly $2 billion a year.

How Do Insurance Companies discover a Fraudulent Slip and Fall Insurance Claim?

1)  Insurance companies have a data base known as the claims index search. Insurance companies share information with each other with respect to claims.  This helps insurance companies fight a potential fraudulent slip and fall insurance claim because companies can see if someone had a prior insurance claim submission. 2)  There is a National Insurance Crime Bureau (NICB).  The NICB has developed a super-secret list of 23 “suspicious loss indicators.” These are items within a claim or its circumstances that signal the claim may be fake. 3)  Insurance companies have also been known to send investigators out to observe you after you file an injury claim.  In the movies, you’ll often see someone faking whiplash after a car accident. After the person gives a false statement to authorities, the movie cuts to the person at home — sans the big foam collar — engaging in an athletic endeavor that would be impossible if he or she really had whiplash. Next scene: A private investigator, hiding in the bushes, snaps a photo of the “victim” and takes off.  That’s not just the stuff of Hollywood. Private investigators do stake out insurance claimants at times for just such reasons. They also use less dramatic tactics to uncover fraud, such as researching claimants’ backgrounds through perusing criminal records, interviewing claimants and any witnesses, inspecting pertinent sites, etc. Investigators may also consult with the insurer’s legal counsel and serve as expert witnesses in court. While some private investigators are hired by insurance companies on a freelance basis, insurers also hire in-house PIs, often selecting those with backgrounds in law enforcement and private investigation 4)  One of the more popular insurance fraud scams involves vehicle crashes that result in both legitimate and fake/exaggerated injuries. The scam can work in many ways. Say you’re in a car crash and your back hurts. You go to the chiropractor, who improperly bills the insurer for nonexistent injuries. Then, maybe lawyers swoop in and persuade you to let them start negotiations for a settlement based on your “extensive” injuries. You end up being part of the scam, but unwittingly. Other times, accident victims are asked to participate in such a scam in return for a cut of the profits.  Typically, those involved in such practices — certain medical providers or lawyers — will perform the same scam over and over. If insurers notice a particular provider submitting numerous claims over time for accident victims that coincidentally receive a similar treatment regimen, that’s a big red flag.  That is how the Philadelphia fraudulent slip and fall insurance claim scandal discussed above was discovered. 5)  Social Media can be used to detect a fraudulent slip and fall insurance claim.  Much like the private investigator who spies the supposedly bed-ridden claimant salsa dancing the night away, insurers are now using social media to check up on suspicious claims. Perhaps the claimant who said his car suffered hail damage will be bragging about his deception on Facebook or Twitter, or will upload a video on Youtube showing how to create fake hail dents in your car’s hood. Who would be that stupid? Luckily for insurance companies, plenty of people. Social media’s biggest application in claims fraud, though, is in disability cases. A quick look at a claimant’s Facebook photos and postings often makes it clear whether the person is truly disabled.


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