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Explaining Insurance Fraud and How to Defeat It 

https://zalma.com/blog

To prove civil fraud it is the obligation of an insurer to present admissible evidence that establishes the requirements of the common law that generally identifies nine elements needed to establish fraud: 1. a representation of fact; 2. its falsity; 3. its materiality; 4. the representer\\u2019s knowledge of its falsity or ignorance of its truth; 5. the representer\\u2019s intent that it should be acted upon by the person  in the man- ner reasonably contemplated; 6. the injured party\\u2019s ignorance of its falsity; 7. the injured party\\u2019s reliance on its truth; 8. the injured party\\u2019s right to rely thereon; and 9. the injured party\\u2019s consequent and proximate injury.  The scams\\u2014Introduction Insureds who are intent on pursuing fraudulent claims employ many  devices, schemes, and artifices that operate to defraud insurance  carriers out of billions of dollars in loss settlements. In an attempt  to collect large loss payments, insureds may make untrue statements  regarding material facts, conceal the true facts, and submit phony  documentation. Values claimed are grossly inflated, deliberate  statements are made concerning nonexistent property, and deception and  inconsistencies abound in the fraudulent claim. Successful handling, investigation, and  defense against such fraudulent and often criminal activity requires a  complete understanding of the various elements of property insurance  fraud, as well as effective investigative approaches.  There are four general types of fraudulent claim activity which  dishonest individuals (insureds and third-party claimants) engage in to  recover policy proceeds fraudulently. Those activities involve the  following: (1) Obtaining insurance under false pretenses by  misrepresenting or concealing material facts in an application for  insurance, (2) Creating a loss, (3) staging a loss, (4) exaggerating the  amount of loss and (5) misrepresenting the cause of loss. Some claims  involve the creation and exaggeration of the loss and some involve all four types of fraudulent  claim activity.    Property Investigation Checklists Uncovering Insurance Fraud, 13th  Edition available from Thomson Reutershttps://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702361