In the investigations of insurance frauds, the strategy is everything

The insurance investigation is all about a balance over the jurisprudence

The insurance investigation is all about a balance over the jurisprudence

When my Italian Investigation Agency takes care of insurance frauds, like compensations for the fake disabled or for large claims, the determinant factor is the coordination with the anti-fraud office of the insurance company and at the same time also with the agent who had insuranced the scammer or the suspected scammer.

Recently, an insured complained that he was not even able to leave his house because of a 100% disability, while in reality he was going to work and having an intensive social life. In order to remain unidentified he was counting on fact that he had an identical twin brother, who declared that was living in the same household. The detectives of my Italian Insurance Investigator Office, in order to reveal this scam, had to identify if in reality there lived the twin brother and to tail them simultaneously. It was possible to use this winning strategy, though, only after taking very detailed photos of the swindler and after showing them to his insurance agent, who has managed to recognize him by several very slight details. It was possible because they were meeting regularly while paying the insurance premiums.

Many practices regarding insurance frauds are managed to the limit of the judicial bluff, because on one hand the government laws favor the self-defense of insurance companies (somebody may speak here about lobby, but to my mind it is a legally confirmed possibility of defence against a constant criminal siege), while on the other hand the trial outcomes are not so obvious, even in the case of very serious evidence. And right here comes in play the work of the Italian Investigation Agency which collects undeniable and strong (but never too invasive) proves, in order to support the out-of-court negotiations, which even before going to the court may win the case for the insurance company.

I remember a false disabled: those who managed the accident had strategically slowed down and then stopped disbursements in his favor, advising us to constantly film him. One of the detectives from my Italian Insurance Investigator Office managed to film him while on the phone with his insurance agent. He loudly claimed he was desperate because of the interruption of his monthly payments, since he swore that he was not able even to go to the toilet without help from his family members. While making this phone call, he was pacing through the corridor in a shopping center where his wife was doing shopping.

Nowadays, in almost all cases, a video like the one we recorded in the shopping center could only be presented in court if they do not have audio. All in all, the anti-fraud specialist of the insurance company showed him this clip, threatening him with criminal complaints and thus obtaining an unthinkable out-of-court agreement against the fraudster.

And the same can be said when the Italian Investigation Agency finds itself defending the legitimate rights of an insured person: if the case is not studied in the smallest details, using all the elements working onĀ  favor of it and presenting them in a proper way, supported by proves, it is very difficult to obtain attention of the insurance company or a right decision on compensation from a judge.