KPI Oklahoma


Although we all hope to have followed all the steps indicated and all the preliminary verifications during the hiring of the personnel of our company, the fact remains that it is inevitable that some dubious elements will always manage to find their place among your ranks! That’s why it’s crucial to learn how to protect your business from insurance scams, to avoid having to contact an insurance investigator!

Here are some insurance scams that are very common and that you may have to manage with the help of an investigator within your company:

  • Scams in the field of health insurance
  • Scams in the field of compensation schemes for workers

There are many other forms of fraud, such as life insurance fraud and motor vehicle scams, but in the case of a business, it is more likely that you will be confronted with insurance fraud involving health insurance fraud or worker compensation scheme fraud. When such cases occur, it is essential to know who to contact and how to use the services of a specialist to help you manage the case.

Insurance Fraud Cases: The Sad Reality

You probably never thought that you would ever have to send insurance fraud files to the authorities, let alone that you would one day need to use the services of an investigator to handle your fraudulent files. However, the fact is that it is very likely that in your daily life, as a manager or business owner, you will have to contact a private investigator.

Before further exploring the various ways in which an employee could commit health insurance fraud or worker compensation scheme fraud, let’s take a few minutes to weigh all the factors to consider when choosing and contacting a private investigator to handle an insurance fraud case:

1.    Longevity and Expertise

Make sure that the investigator you hire has considerable expertise in the field and an irreproachable history of insurance fraud management in your community and in the surrounding areas. This is not the kind of case you want to put in the hands of a beginner!

2.    Certification and insurance

Before entering into a business relationship with a private investigator, ensure that the agency in question is:

  • Adequately insured
  • Certified according to the standards and criteria in place in your regional context

3.    Reputation and visibility in the community

It is essential to choose only an investigator whose reputation, whether on Google or by word of mouth. The agency must have a website and be a company whose caliber and status you can check on the web.

Now that you’re a little more up-to-date on the factors to consider when contacting an insurance fraud investigator, here are some examples of situations that could lead you to having to forward insurance fraud files to the appropriate authorities:

Worker Compensation Plans:

Does your employee have, or has it actually suffered the sequelae of the severity mentioned? Did the accident really happen in the workplace or elsewhere? These are the kinds of questions that the investigator can target and solve.

Health insurance:

Has your employee submitted false claims under the health insurance policy to which the company subscribes? Again, make sure you use the services of an investigator to handle these types of cases.

We would all like to never have to deal with this kind of situation in our business, but the lesson here is to realize that if you are equipped to recognize and manage fraud, you are already on track to find the solutions. Be careful and reasonable; if you face fraud, talk to a specialist and let them handle the often-unpleasant task of dealing with it.

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