5 Ways to Identify and Prevent Fake Personal Injury Claims



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Insurance companies spend millions of dollars each year investigating and prosecuting fake injury claims. While a fair number of fraudulent claims slip through, companies catch and deny many more. Some of the most serious cases of fraud wind up in criminal courts.

Unfortunately, honest, hard-working people end up paying for the sins of others. Insurance companies simply pass on the costs of investigating fraudulent claims to their customers, in the form of higher premiums.

In this section, we look at what you can do to prevent your insurance company from paying a fake injury claim filed against you. Let's begin by looking at how insurance companies classify fraudulent claims.

Categories of Fraud

  • Hard fraud is serious. It occurs when one or more people stage accidents, or when they conspire to invent circumstances resulting in real or feigned injuries. Insurance companies and the police take this very seriously. This type of fraud has civil and criminal penalties.

  • Soft fraud is more common. It occurs most often in legitimate claims, when claimants exaggerate their injuries to run up their damages. Claimants can also fake an injury by falsely using a prior injury as the basis for a new claim.

Fake injury claims aren't limited to vehicle collisions. People also file them on alleged slip and fall accidents, defective products, assaults, dog bites, work accidents, medical errors, and more.

It's virtually impossible to stop a dishonest person from filing a fraudulent claim. All he needs is some basic evidence of the accident, your name, and your insurance company's phone number. But, there's a big difference between filing a claim and actually getting paid.

How to Stop Fake Injury Claims

1. Police reports and their absence

Call the police if you're in an auto accident. Often, the police won't come to an accident scene unless someone is injured, the wreckage is blocking traffic, or the scene poses a danger to others. If you and the other driver and passengers suffered only property damage, the police may not respond.

Make a note of what happens at the scene. The absence of complaints of injury after the accident can help disprove a fraudulent injury claim, although it is possible for the symptoms of whiplash and other soft tissue injuries to appear days later.

2. Claimant's statements

When a claimant blurts out something at the scene, especially when it's related to his actions or physical condition, the circumstances of that statement are normally admissible in court as evidence of the truth. These are known as "Res gestae" statements, and "Admissions against interest."

"Res gestae" statements

If, at the accident scene, the claimant said, "I'm alright," or "I'm not hurt," or words to that effect, those statements are considered res gestae (exceptions to the hearsay rule).

These statements are strong evidence, because the claimant made them at the time of the collision. The courts' reasoning is, when a traumatic event occurs, most people don't have time to come up with falsehoods. If they say anything right after an injury event, it's usually the truth.

Admissions against interest

If, at the time of the collision, the driver of the other car said something like, "I'm sorry. I was going too fast," or "I didn't see you," or any number of similar admissions of fault, those statements are considered admissions against his interest. They're credible statements showing his state of mind close to the time of the collision.

Lawyers often use statements like these in court to prove or disprove claims for compensation based on fault.

3. Witness statements

After speaking with the other driver and his passengers, look for witnesses to the accident. Find as many as you can, and make sure you get their statements and contact information.

Witness statements can be invaluable, especially when they're given by people totally unconnected to the accident (e.g. passersby, store owners, other drivers, etc.). These people have nothing to gain from giving their testimony.

For example, a passerby may have noticed, immediately after the accident, the other driver was walking without difficulty. Later, if the driver claims his leg was hurt in the collision, the witness's statement will help prove the driver is greatly exaggerating, or even faking his leg injury.

4. Photographs

Photographs are strong evidence. Showing the cars as they looked immediately after the collision and at the point of impact can go a long way in disproving claims of serious injury.

Use a digital camera or your cell phone to photograph the accident scene, the driver, and his passengers. Photographs and videos of the driver and passengers laughing, or speaking on their cell phones, can be dramatic proof they're exaggerating or faking their injuries.

5. Your Insurance Company

As soon as possible after the accident, notify your insurance company. You have a responsibility to do so, regardless of fault. Tell the insurance representative you had an accident. Also tell her you're quite sure the other driver and his passengers were not injured, or at least, not seriously.

Tell her why you believe no one was injured, and offer to provide any evidence you have supporting your position. Insurance companies despise fraudulent claims. They will welcome credible evidence from customers and independent sources.

Other Claim Types

This all applies to other types of personal injury claims, including slip and falls, work injuries, and dog attacks. Whether you're a homeowner, business owner, or landlord, you can protect yourself from fraudulent injury claims. The more evidence you can provide your insurance company, the better the chance they'll deny the claim.

There's only so much you can do to protect yourself. Once a person files what you believe is a fraudulent claim, it's up to your insurance company to decide whether to pay the claim or deny it. You can't legally force your insurance company to deny a claim.

Your insurance company may welcome your evidence or reject it. Despite your best efforts, the company may decide to go ahead and settle. The claims adjuster may not think there's enough evidence of fraud, or believe it's cheaper for them to pay the claim. Unfortunately, the result for you can be higher premiums or, in some cases, a canceled policy.

Case Studies:

Auto Accident Lawsuit Between Two Insurance Carriers
In this case study, an insurance company is trying to recover payment they made for their insured's damages from the at-fault driver's insurance company (also known as subrogation).

Lawyer Fails to Present Sufficient Medical Evidence
In this court case, the plaintiff's personal injury lawyer is seeking damages after a car accident, but he can't prove the plaintiff meets the serious injury threshold. The defendant files to have the case dismissed for lack of evidence.

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Disclaimer: Information provided in our response is NOT formal legal advice. It is generic legal information based on the very limited information provided. Under no circumstances should the information in our response, or anywhere else on this site be relied upon when deciding the proper course of a legal matter. Always get a formal case review from a licensed attorney.

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