It is estimated that eight million emergency room visits per year, nearly 22 percent of all emergency room usage, are attributed to slip and fall accidents. This makes slip and fall accidents the number one cause of emergency room visits, and one of the top types of personal injury lawsuits filed in the United States. Billions of dollars are paid out each year in slip and fall claims, and insurance fraud is at the core of many of those cases.

From 2010 to 2011, the number of insurance fraud investigations went up 12 percent. This represents the steady increase of insurance fraud cases seen throughout Philadelphia and around the country. The potential for fraud is what motivates the need for an insurance investigation, and the hope is that the investigation will prevent the insurance company from having to pay out money to a scam artist.

What Is An Insurance Investigator?

Investigation desk lamp

Insurance companies either have investigators on their payroll, or they outsource their insurance investigation work to professional organizations. An insurance investigator does comprehensive research to make sure that a claim is not fraudulent. The investigator uses a variety of methods to determine the potential motivation for fraud, any history of fraud a claimant may have, and the proof that fraud exists.

In most states, insurance fraud is a felony. That means that anyone caught perpetrating fraud will go to jail and possibly be fined. Because fraud is a felony, it is common for local law enforcement officials to get involved when a slip and fall accident occurs.

However, most law enforcement agencies throughout the United States are too busy to investigate every case. If there is clear-cut evidence of fraud, such as a video of the incident, then the police will usually make an arrest. But insurance companies often have to use their own investigators to put together the evidence necessary to initiate an arrest.

How Does An Investigation Work?

Insurance investigators are usually licensed or certified, and they are required to submit official reports to their companies for each investigation. Since insurance fraud costs the insurance industry billions of dollars each year, insurance companies find that investing in a full investigation for each incident can keep their losses due to fraud down.

An investigator will collect as much information as possible on the incident, the victim, and any other facts surrounding the case. If a victim claims a serious injury in a small retail shop, then the shop owner might feel compelled to pay a settlement to avoid insurance issues. But if an investigation is allowed to take place, the investigator might photograph the victim jogging in a park when they claim they can barely move. When a fraudulent claim is discovered, it saves the insurance company and its client money.

The Consequences Of Insurance Fraud

Slip and fall fraud is one of the most common types of crimes committed against insurance companies, and that Magnifying glass fingerprintsmoney has to be made up in some way. Because of slip and fall fraud, insurance premiums are higher than they should be and the scrutiny applied to real claims is more stringent than necessary. In addition, due to fraud, real claims are often denied and victims are forced to either recover from their injuries without a settlement or take the insurance companies to court.

American businesses spend billions of dollars each year trying to prevent fraud. From in-store security to elaborate camera systems, American businesses that are open to the public are forced to invest more money and resources in preventing fraud. When this happens, the cost of goods and services to the public goes up.

Slip and fall fraud affects everyone. It causes insurance premiums to go up, it costs businesses more money, it causes the cost of goods to go up, and it forces legitimate victims of slip and fall accidents to be subjected to tight scrutiny. There are people who make their living committing slip and fall fraud, which means that it is a crime that is not going away anytime soon. The more money insurance investigators can save insurance companies by catching and prosecuting scam artists, the less everything costs for everyone else.