Background checks are not merely about verifying identities but delving into critical aspects of a claimant’s history that can make or break a case. Frasco® Investigative Services, a leader in specialized investigative practices, emphasizes the indispensable role background checks play in enhancing claims investigations, empowering claims adjusters and risk managers to make informed decisions.
Background checks enable insurers to validate the accuracy of information provided by claimants, uncover potential fraud, and enrich the investigative process with valuable context. By examining employment history, past claims, criminal records, and other key data, investigators can detect discrepancies and red flags that might otherwise go unnoticed. This thorough approach not only protects the integrity of the claims process but also maximizes recovery opportunities, ensuring favorable outcomes for insurers and policyholders alike.
The Role of Background Checks in Claims Investigations
- Verifying Information
Accurate information is the foundation of any investigation. Background checks vet provided and collected information for accuracy:
- Claimant details, such as employment history and medical records, align with the information provided.
- Preexisting conditions or past claims are identified, offering clarity on the legitimacy of current claims.
- Discrepancies that indicate potential fraud are flagged for further scrutiny.
- Uncovering Fraud
Fraudulent claims are a significant concern in the insurance industry. Background checks serve as a proactive measure by:
- Identifying red flags through financial pressures, social circumstances, or patterns of past fraudulent activities.
- Leveraging advanced sources to uncover special licenses or certifications that could open opportunities for undisclosed employment, or conflicting statements.
- Utilizing social media elements to expose activities inconsistent with reported injuries.
- Enhancing Investigation Outcomes
Comprehensive background checks provide a deeper understanding of the claimant and their circumstances, enabling investigators to:
- Build detailed profiles that support targeted investigations.
- Develop evidence-based strategies for resolving claims efficiently.
- Optimize resources by focusing on cases with red flags.
A Tiered Approach to Background Investigations
Phase 1: Initial Screening
Experienced investigators review claim files using:
- Proprietary Subscription Data: Access to motor vehicle registrations, credit header information, and business ownership records provides an initial overview.
- Open-Source Intelligence (OSINT): Publicly available information, such as social media, online profiles, and public records, is analyzed for inconsistencies and potential red flags.
- Red Flag Criteria: Pressure, opportunity, and rationalization are evaluated to identify cases warranting further investigation.
Phase 2: In-Depth Analysis
When initial findings suggest potential fraud, deeper investigations are conducted:
- Data Verification: Cross-referencing claimant information with local government records and additional proprietary sources.
- Social media and Network Analysis: Reviewing claimants’ online activity and connections for evidence that supports or contradicts their claims.
- Medical Sweeps and Status Verification: Assessing whether injuries are consistent with medical records and claimed activities.
This tiered approach builds on cross-refenced data points to maintain thoroughness across all steps of the investigation, to reduce the likelihood of missing a telling detail, or on reporting a false positive, (like confusing the claimant with another person with the same name).
Leveraging Advanced Techniques
Open-Source Intelligence (OSINT)
OSINT provides investigators with access to vast amounts of publicly available data, including:
- Web Scraping: Automated extraction of relevant information from websites.
- Social Media Analysis: Monitoring platforms for posts, photos, and connections that provide insight into claimants’ activities.
- Geospatial Analysis: Using mapping tools to confirm locations and validate claims.
Proprietary Data Sources
Access to premier investigative databases enables:
- Verification of addresses, relationships, and employment history.
- Identification of bankruptcies, foreclosures, and criminal records.
- Enhanced profiling through aggregated data from motor vehicle records and financial databases.
These techniques, combined with expert analysis, provide unparalleled insights that improve the accuracy and efficiency of claims investigations.
Conclusion: The Indispensable Role of Background Checks
Background checks are a cornerstone of effective claims investigations, offering a robust framework for validating information, detecting fraud, and optimizing recovery efforts. Their ability to uncover hidden details and provide actionable insights ensures that insurance companies can process claims with confidence, fairness, and precision. By integrating these investigative practices, insurers not only protect their bottom line but also uphold the integrity of the claims process, fostering trust and accountability within the industry.
The Frasco Background Check
Frasco® Investigative Services for 60 plus years has led the way in innovative background investigation solutions, empowering insurance professionals with the tools and expertise needed to navigate the complexities of claims investigations. With a commitment to thoroughness, accuracy, and efficiency, Frasco delivers results that elevate the standard of excellence in the insurance industry.
Contact Us Today
Frasco® Investigative Services delivers ethical and efficient solutions tailored to your needs. Have questions or want to discuss your investigative needs further? Contact one of our experienced experts today to find the answers you’re looking for.
Disclaimer: This blog post is for informational purposes only and should not be considered legal advice. Please consult your general counsel for specific legal guidance. Frasco investigators are licensed, and our operations comply with US industry, federal, state, and local laws.