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 that 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 institution undertaking anti-fraud investigations in Chinese mainland, Beijing Steele Business Investigation Center has achieved a great success in this field. The following case is to illustrate the diversity of insurance fraud, aiming to exchange opinions with people in the same business and enhance the strength of prevention insurance fraud. Steele has dealt with such a commission successfully, which was from an American insurance company to investigate a traffic accident, which had happened in Hunan province, and the whole family members of the insured were killed in it. The insured, Mr. Zhang Feng, was a Chinese American, 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 with million dollars. During the process of investigation, Steele’s investigators found some suspicious points from the Documents of Traffic Accident Liability, the Death Certificate and the Cremation Certificate, from which 1. The official seal on the Document of Traffic Accident Liability from the Traffic Police Branch of the city used 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 are modification marks on the Cremation Certificate, and the letters are not legible enough. The investigators of Steele unveiled the truth after their investigators’ precise pursuit, and 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 did 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 given the emergency treatment for the insured’s family members in a traffic accident. In addition, there should be a "red star" instead of a "red cross" in the center of the seal. There is 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 the documents enclosed, although those three certificates and the series numbers were existed. Referred to the computer records and receipts, the fact revealed that those certificates were for other people. The beneficiary just 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 a heavy loss for it.

Here blow is another case.                                                       

In May 2000, Steele was entrusted by American Life Insurance Company to investigate and verify the truth of one medical document case of Tong. The insured, 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 contestable 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. By verification with the hospital conducted in the rumor section of certain hospital, it was learned that Tong really died of liver cancer on March 21, 2000, which conformed to the statement of the beneficiary provided. So the investigator prepared the investigation report for close this case, when just before finishing the investigation, the investigator examined the medical records in order and found a sentence "once hospitalized/had ever hospitalized in a hospital" in it. The investigator was awoken by this sentence, subsequently started He attached great importance to it and started a deep investigation on this point. Since no capital The hospital’s was unknown, so name was mentioned in the medical record, it was quite hard difficult for the investigator to find out the hospital where the insured had ever been treated. It was widely known that as a large Chinese Province , Fujian Province had at least one thousand hospitals of different levels. Where was the starting point? The investigator carefully analyzed the basic information about the insured, as well as how an ordinary people choose a hospital when he/she was taken a serious disease, the place of birth and the information about hospital selection criteria in order to find clues. Based on the information collection and analysis, he concluded that most Chinese returning from abroad would choose large-scale comprehensive hospitals. Therefore, investigation and verification were conducted in big Provincial hospitals. Hard working was rewarding. The investigator learned at last that Tong had been hospitalized in one affiliated hospital belonging to Medical University of Fujian Province. In the affiliated hospital, the insured was diagnosed that had suffered from 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 they made 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 the relatives in United States . Since China is far away from United States and the language is different, the insured thought that the American insurance company was unable to know about backstage manipulation and, in succession the insurance company would have had to pay the compensation according to the insurance 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 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 state of an illness condition,  multi-effecting of single insurance and aggrandizing the bid value. If you want to know more information and know more about Steele, please contact us. Steele can provide professional services for your want with its professional skills.