Diversity of insurance fraud

Some people consider insurance fraud as a recent thing that firstly appeared only one or two decades ago. The main reason is in the past time insurance fraud was not exposed or its latent existence was ignored. In fact, insurance fraud has existed for a long time in western countries. It is one of the most popular white-collar crimes in United States. As the first professional institutions undertaking anti-fraud investigations in Chinese mainland, Beijing Steele Business Investigation Center has made great success in this field. The following case is to illustrate the diversity of insurance fraud. The aim is to exchange opinions with people in the same business and strengthen the strength of prevention insurance fraud. Steele has dealt with such a commission successfully from an American insurance company to investigate a traffic accident, which had happened in Hunan province, and the whole family of the insured was killed in it. The insured, Mr. Zhang Feng, was a Chinese American, have had bought life and accident insurance for his family. The beneficiary Zhang Li provided the relevant certificates to the insurance company and claimed for the compensation as high as several million dollars. During the process of investigation, Steele’s investigators found some suspicious points in the Document on Traffic Accident Liability, the Death Certificate and the Cremation Certificate. 1. The official seal on the Document Traffic Accident Liability was from the Traffic Police Branch of the city was use an abbreviated name of the Police Branch, but such situation is impossible in China. 2. There is a red cross in the center of the official seal on the Death Certificate instead of a red star as the demand in China. 3. There have modification marks on the Cremation Certificate, and the letters were not legible enough. The investigators of Steele unveiled the truth after their precise pursuit, they found the evidences as follows: Firstly, the Document of Traffic Accident Liability and the seal were faked. It was confirmed that the Traffic Branch had never handled such a traffic accident on May 26, 1998. Moreover, the full name of the Traffic Branch is not accord with that on the document. Secondly, the Death Certificate and the seal were both faked. It was confirmed that the hospital had never give emergency treatment to the insured’s family in a traffic accident. In addition, there should be a "red star" instead of a "red cross" in the center of the seal. There has no a doctor whose family name is Feng in the hospital. Thirdly, the Cremation Certificate was fabricated from a photocopy of a certificate. Records obtained from the funeral parlor were inconsistent with documents enclosed. Although those three certificates and their numbers were exist, referred to the computer records and receipts revealed that they were for other people. The beneficiary photocopied them and fabricated those documents. In front of the facts and evidences, an insurance fraud was unveiled.

In this insurance fraud case, Steele succeeded in effectively preventing one fraud for the insurance company and avoided big loss for it.

In May 2000, Steele was entrusted by American Life Insurance Company to investigate and verify the truthfulness of one medical document case of Tong. The insured, was 51 years old, came from Lianjiang City of Fujian Province. He has insured himself against disease in American Life Insurance Company. He died of liver cancer in a hospital of Fujian Province. When the insurance application was made in January 2000, it was still in the period of dispute. The insurance company wanted to know whether he had been treated because of the liver cancer during the period from 1998 to January 2000 or not. The investigator carried out multi-channels and comprehensive investigation after a thorough analysis. During the verification conducted in the rumor section of certain hospital, it was learned that Tong really died of liver cancer on March 21, 2000. It conformed to the statement of the beneficiary provided. Just before finishing the investigation, the investigator examined the medical record and found the term "once hospitalized" in it. He attached great importance to it and started a deeply investigation. Since no capital name was mentioned in the medical record, it was quite hard for the investigator to find out the hospital where the insured had been treated. It was widely known that as a large Chinese Province, Fujian had one thousand hospitals of different levels. Where was the starting point? The investigator analyzed carefully the place of birth and the information about hospital selection criteria in order to find clues. He concluded that most Chinese returning from abroad would choose large-scale comprehensive hospitals. Therefore, investigation and verification were conducted in big Province-level hospitals. Hard working was rewarding. The investigator was learned at last that Tong had been hospitalized in one hospital belonging to Medical University of Fujian Province. He was diagnosed that had suffered liver cancer there. . Investigations undertaken by Steele provided the insurance company with true and detailed report supported by all kinds of data and certificates enclosed. This fraud case failed, too.

As we mentioned above, these cases both involved effecting insurance in United States and requesting compensation when event happened after the insured returned to China. It is obvious that the insured make use of the geographic and language differences between two countries. Why did they choose the same approach? All documents were provided by the beneficiary in China or submitted by relatives in United States. Since China is far away from United States and language is different, the insured thought the American insurance company was unable to know about their backstage manipulation and would have to pay compensation according to the contract. Such an approach seemed also attractive to potential insurance defrauders. With the rapid development of insurance industry, the domestic and international insurance companies are paying more and more attention to insurance frauds. In China, the professional services against insurance and commercial frauds provided by Steele have been highly thought both in insurance industry and business industry.

There are numerous various insurance frauds. Besides the above-mentioned means of fake certificates and insurance effecting after the occurrence of accidents, there are also other means such as hiding patient's condition, multi-effecting of single insurance and aggrandizing bid value. If you want more information and know more about Steele, please contact us. Steele will provide services you want with its professional skills.