How do insurance companies verify receipts? Many companies and insurance clients ask this question today. In the event of an accident, having insurance coverage reduces your losses, but only until your insurance claim is approved. According to the Coalition against Insurance Fraud, unauthorized insurance claims via receipts cost $67 million each year, and 10% of people believe insurance fraud is a minor crime.
Because fake claims boost insurance premiums for everyone, it’s in a company’s primary interest to ensure that each claim is valid and correct. Auto accidents, injuries, work accidents, and property damage are typical insurance claims that require a receipt review.
Continue reading to learn more about what an inquiry like this takes, as well as instances of typical claims and how insurance providers check receipts.
What is a Claims Investigation in the Insurance Industry?
Insurance providers frequently conduct claims investigations to determine the validity of a claim. The claims adjuster can use the investigation process to make an informed judgment on how to handle a claim.
In the quest to combat the occurrence of fake or inflated receipt claims, insurers’ investigations are used. An invalid claim is unreasonable or wrong, and by detecting it early, professionals can avoid paying a fraudster potentially large sums of money.
Insurance claims investigators use evidence, interviews, and documents to determine if a receipt claim is real or fraudulent. Depending on the type of claim, there are many sorts of insurance receipt investigations. Here are a few examples:
Claims for damage to property
Property damage claims are submitted by homeowners, business owners, and landlords. The amount of the claim is determined by the seriousness of the situation and the type of property. If the claim is significant, the insurance provider will appoint an expert to assess the property damage, the cause, and other receipt information. The outcome of the investigation will decide how the insurance provider handles the claim.
Compensation for personal injuries
Victims of automobile accidents and other disasters can file a personal injury claim with receipts to receive benefits for their injuries. In the quest to decide if the victim is eligible for compensation, the claim investigation will look into the cause of the car accident. If the investigator learns that the automobile accident, damages, and receipts were all made, the personal injury claim is fraudulent.
Claims for workers’ compensation
Employees who are injured at work can file a workers’ compensation claim for compensation. This reimbursement will cover their time spent away from the office.
Suppose the company does not have workers’ insurance. In that case, the injured worker is not a genuine employee, the worker’s ailment or condition is not work-related, and the worker or employee submits fake receipts, the request will not get approval.
Medical/healthcare fraud claims
Medical practitioners are compensated for their services by submitting medical claims and invoices to the client’s insurance provider. Fraud happens when a doctor or a patient pushes up the cost of health care treatment and keeps the difference.
How do Insurance Companies Verify Receipts
Insurers lose over a billion dollars yearly due to false claims. According to statistics, there were approximately 760,000 false claim cases in the United States in 2020. The insurance receipt verification procedure, also known as the claims investigation process, aids insurers in distinguishing between legitimate and fraudulent claims.
The procedure of investigating claims is similar to that of other inquiries. It entails several processes, including gathering and evaluating receipts, taking statements, tracking witnesses, checking and capturing the damaged items or accident scene, performing surveillance, and researching social media accounts. Below is how do insurance companies verify receipts they do it:
Gathering and examining documents
Typically, insurance companies may request and gather official receipts and other information related to the accident or damage during the assessment of your claim.
They can look for official receipts generated by the clinic or the victim’s physician for a personal injury claim. They also get medical release paperwork, medication data, physician’s notes, and any other documentation that can prove the injury’s legitimacy and severity.
In a damage claim resulting from a car accident, insurers will also ask for a copy of the police and accident reports. These records will include details from the day the accident was reported and can be utilized to back up statements, receipts, and other information gathered through interviews.
They frequently ask for receipts or images confirming the stolen item belong to the victim in a property theft claim. Unfortunately, a true victim of property theft may begin inflating their claim with extra stuff they don’t own. Firms can avoid fraudulent claims by requesting proof of these items.
Obtaining statements and conducting interviews
During an insurance receipt claim investigation, insurance companies will typically interview the victim, witnesses, and, if applicable, the culprit. This is one of the finest ways to acquire information.
The questions they ask will vary depending on the allegation. They frequently question what was taken, when they first noticed something was wrong, and the identities of any individuals in the house at the time of the theft in a burglary claim. Some insurers will read the actual police report loudly to the claimant and observe how they react.
In addition, certain insurers will typically want a documented or written account from all individuals involved, explaining the occurrence and circumstances. It will be easier for businesses to evaluate current data to what was previously presented if they can hear or read the statement later.
Seeking assistance from computers
The software serves to identify abnormal billing and receipts, thanks to technological advancements.
Investigators use this program to pull billing records to look for fraudulent activities. It makes no difference what kind of insurance you have. The computers investigate the statements’ authenticity using data and trends. These computer software packages seek several procedures on one claim for the same body area for health claims.
Furthermore, they can detect fraud on any sort of insurance receipt, including car insurance, in the end.
Making a personal information request
Expect a call from the insurance adjuster whether you or someone else is at fault in a property or car collision. The adjuster will collect personal data such as your residence, complete name, birth date, health insurer, physician doctor, and so on as part of the insurance receipt verification procedure.
The firm will enter all of the information you supply into a statewide database that contains statistics about:
- Historical and contemporary insurance contracts
- Previous claims
- Previous vehicle accident injuries, among other things
If the details you submitted conflict with the information in the database, it could imply fraud and hamper your receipt recovery procedure. Similarly, if your information suggests that your current injuries were caused by a past accident, the amount of money granted by your insurer may be less than you anticipated.
Before revealing your personal and receipt details to an insurance adjuster, speak with counsel to protect your interests and privacy. If you’re at fault, you should seek legal guidance immediately.
Information gathered from third parties
The insurer may also ask anyone who witnessed the incident for proof. In addition, the investigation team may contact friends and family members of the claimant as third parties. The third-party doesn’t need to be a recipient of the respondent’s insurance scheme.
You must give the adjuster the contact details of anybody who can provide information about your receipt claim. However, it is not your responsibility to coerce anyone to reply to the insurance adjuster’s inquiries.
Because a third party refuses to answer questions, insurers cannot refuse to pay a receipt claim.
It’s worth noting that having a third party work with the assessor can work to your advantage if they have data that will help you prove the accuracy of your receipts.
Frequently Asked Questions
How do insurance companies verify receipts?
Insurance fraud raises insurance premiums for carriers, applicants, and everyone else. To protect their financial performance, insurers must verify the authenticity of a receipt before granting reimbursement.
Receipt investigation services are required for property damage, car accidents, and personal injury. It is impossible to determine who is at fault and who is entitled to repay without it. Property and car insurance companies also scrutinize receipts to see if the applicant is acting in bad faith and attempting to defraud the insurer.
The following are the steps involved in verifying receipts:
- Gathering and Examining Documents
- Obtaining Statements and Conducting Interviews
- Seeking assistance from computers
- Making a Personal Information Request
- Gathering information from third parties
How do insurance investigators conduct their investigations?
Insurance investigators check into your past claims and receipts to see if there are any red flags.
Do insurance companies carry out their investigations?
Yes. Insurance companies frequently conduct claim investigations to determine the validity of a claim.
What is the time limit for an insurance company to resolve a claim?
Insurers have between 50 and 80 days to resolve a claim after you file it.
In conclusion, verification of insurance receipts is a popular practice among many firms today. And if you need more information in this regard, the highlight above will aid you immensely.
Nicholas J. Banks has been an expert in the Insurance industry for over 10 years. He is well-versed in all aspects of insurance, and he has worked on Allstate Ins Group since 2006.
He attended the University of Pennsylvania with an undergraduate degree in Business Administration, followed by a Master’s degree from the University of Southern California to further his career in Insurance Management.
His experience working with many different companies has helped him develop valuable insight into how to succeed in this exciting field, which he now shares through our blog “Pro Insurance Info.”