"Start with subtle points" ---- the basic element of investigation

This article describes means of insurance frauds with a typical case of insurance fraud, which was handled successfully by the author himself. Seeming simple and reasonable, this usual insurance case turned out to be a fraud through investigation starting with traces. The importance of insurance claim investigation in insurance industry is well illustrated in this article.

Beijing Steele Business Investigation Center undertakes various cases related to insurance claim fraud. Investigation approaches and methods should vary for different cases with diverse motivations and means. One investigator in our center once accepted a case and finally found out the truth after a seemingly hopeless investigation.

In January 2000, a certain American Insurance Company faxed to Steele and demanded it to investigate the truthfulness of death of one insured. Relative information was provided: Wang Feng, male, aged 50, Chinese with American nationality. He affected one health insurance in American Big XX Insurance Company in 1998. In June of the same year, he returned to China. At the end of June 1999, he died of pneumonia in the local hospital of his resident place--Changle of Fujian Province. Then the beneficiary requested compensation. On commission, Steele designed the plan and undertook the investigation soon. The investigation revealed that Wang Feng went to see doctor of city hospital of Changle many times because of infection of lungs on February 15, March 10, March 20, and April 5 2000. The above data coincided with the medical record provided to American Big XX Insurance Company by his relatives. Anyway, very few doctors pointed out that Wang Feng's pneumonia was not deathly. Meanwhile, with acute sense, the investigator discovered that there were very subtle inconsistency about death time and emergency treatment procedure. What's more, some cadre of village committee once saw Wang Feng being sent back home in an ambulance in the middle of April. It was learned that the city hospital of Changle was a county-level hospital without imported ambulance. Until then, a tentative judgment was formed that Wang Fang had been treated in other medical institutions. So the investigator redesigned action plan and contacted five province-level big medical institutions. At last, real situation came from the XX hospital belonging to Medical University of Fujian Province: Wang Feng's disease was diagnosed certainly as liver cancer in March 1998 and was hospitalized. Because of ineffectiveness of treatment, he was discharged as required by his relatives in June. Here the truth was revealed and made public: the insured attempted to gain insurance by hiding the medical situation and fabricating medical records.

Above case is one typical kind of life insurance fraud. Defrauders often play the trick described there. The insured suffered from liver cancer and also died of it. When the liver cancer was treated, he went to the county hospitals several times claiming suffering from pneumonia. False facts were made up to get great amount of insurance by hiding the real cause of disease. In this way, the insured plundered insurance by grafting. Seemingly, this insurance claim conformed well to rules, for the insured provided the medical certificate from one county-level or higher medical institution. Home was cleverly chosen as death place. The municipal government provided the death certificate, too. All of these false facts were formal and mutually supporting so that claim seemed justified. Anyway, there must be a careless omission in one thousand considerations. The truth can't be always concealed by the false. The objective and careful investigation had defrauders' tricks become in vain.

It was turned out through investigation that Wang Feng was originally from Changle of Fujian Province. In middle of the 1980s, he stowed away to USA. For many years, he took hard jobs such as dish washing and goods carrying. It was reasoned that he himself should have been aware of his hopeless disease in America and had spent all of his savings on treatment. He decided to return to China in order not to die abroad. Before the departure, he bought health insurance in order to leave heritage for his family. The pains were proved to be in vain. Despite the complex emotional background of such case, the investigator has abided by the principle of objectivity and revealed the truth with no mercy, for it is the investigator's obligation to find out the truth.

The gloomy psychology and concealed techniques of the defrauder were demonstrated in this case. In the viewpoint of investigation, the overall victory can only be achieved through starting with subtle points, inquiring from various aspects, making comparisons and finding out flaws. Take the above case as an example, the investigator just found clues through such subtle points as two different descriptions of death time and emergency treatment procedure, and the fact of insured being taken back home in an ambulance witnessed by somebody. This is a good example presenting the usefulness of this method: starting with subtle points.