What is insurance fraud?

  • According to Wikipedia, insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due.

    There are many types of insurance fraud. Click here to learn more about some of the types of insurance fraud.

  • The fact is that insurance fraud occurs everywhere in the state and takes many different forms: workers compensation fraud; owner give-ups in the auto theft arena, arson and fraudulent theft claims in the homeowners arena all cost many millions of dollars in fraudulent claims. That, in turn, increases insurance premiums for all New Yorkers.

    • Plant enough trees to reforest all of New England plus most of West Virginia.

    • Pay the healthcare costs for nearly 2 of every three seniors aged 65 and over for a year.

    • Buy a new car for nearly 3 million licensed drivers.

    With 80 billion dollars...you’d be pretty busy wouldn’t you? Unfortunately, in the US, that amount of money goes up in flames every year because of insurance fraud. Insurance policy holders across New York State are victimized to the tune of more than half a million dollars a day. That’s money coming straight out of your pocket. And if you are a business owner, the daily cost to you is even higher.

    Fraud is the crime you pay for! It claims many victims; families, businesses…anyone in New York. Don’t allow your business, your employees or your family to be victims. The fight against fraud begins with being able to identify it.

  • Each and every one of us needs to take a zero tolerance attitude toward insurance fraud. Here are some actions you can take:

    1. You have the power to help. Educate yourself, and if you are an employer, educate your employees on how to spot insurance fraud and stop it. Here are some things to watch out for:

    • Be cautious of attorneys or telephone callers who allege to be insurance representatives and immediately solicit your business for treatment at a medical facility following an accident.

    • Check your doctor’s and attorney’s credentials. Before seeking medical treatment or legal counsel, contact the New York State board for medicine for information on physicians or the New York State Bar Association for information on attorneys.

    • Be wary of referrals. Attorneys involved in medical mill operations will oftentimes insist an accident victim seek medical treatment from a specific doctor.

    • Don’t be talked into an injury. Be cautious if your doctor prescribes excessive treatment for minor injuries. Seek a second medical opinion when, for example, your doctor recommends testing, x-rays and medication for your “severe back pain” when in reality you don’t feel any back pain at all.

    • Talk to your insurance company. Maintain records of your office visits and treatments, and provide them to your claims representative, who can compare them to medical bills, uncover any discrepancies and avoid unnecessary payments to dishonest medical providers.

    2. Most important of all, don’t commit insurance fraud and if you see it happening, report it.

    3. And finally, pass our information along to everyone you know.

STAY INFORMED