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How to fight insurance fraud



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Insurance Fraud is a crime in most states in the United States. The victims of the crime of insurance fraud are insurers – no one else. The crime is committed by any race, gender, national origin, religion or sexual orientation.

The crime of insurance fraud takes from the insurance industry and, as a result, the general public to insurers, ranging from $ 80 billion to $ 300 billion. every year. No one knows the real amount because most insurance fraud attempts succeed.

I have been involved in insurance companies' attempts to defeat insurance fraud for almost 54 years. I've seen scams succeed. I have had clients force a fraudulent claim with extensive evidence that is sufficient to prove the fraud in addition to a predominant portion of the evidence, to avoid the risk of bad faith. The only way, in my experience, to defeat insurance fraud is to take the profits from the crime. Prosecution does not take the profits from the crime because there are few arrests, fewer convictions and most sentences, even after a conviction, are lenient and often do not require full repayment.

As a result, many insurance companies refuse to trust the police. Also state insurance fraud departments or insurance fraud agencies, due to lack of success for these agencies to reduce insurance fraud. Brave insurance companies have decided to refuse to fall victim to fraud. They refuse to pay. They take fraud cases to court and appeal all negative judgments. Some are beginning to take advantage of whistleblower provisions in state insurance fraud prevention laws (IFPAs.)

California regulations describe a thorough investigation in section 2698.36. "Investigation of suspected insurance fraud" explains what is required to complete a thorough investigation.

It requires the SIU to establish, maintain, distribute and follow written procedures for investigating any suspected insurance fraud. An investigation of any suspected insurance fraud shall include:


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