Exposing Staged Accidents with Cross-Referenced Evidence

Staged accidents are a costly threat to insurers. From fraudulent injury claims to inflated damages, these deceptive practices drive up premiums, increase payouts, and create legal exposure that can take years to resolve.  In fact,

Recent reports from 2022 show that the largest concern insurance companies have is keeping up with fraudsters modus operandi (FRISS). For some perspective, for the prior 5 years in a row the largest concern was internal data quality.

How Can Cross-Referencing Evidence Help Confirm a Staged Accident?

There are substantial benefits that come from cross-referencing data to conclude a claim.

Medical Records: Medical records are reviewed for inconsistencies between reported injuries and the nature of the accident. For example, a staged accident might involve claims for severe injuries that are inconsistent with the scene’s evidence. It’s important to cross-check medical bills against the actual treatment provided. Excessive or unnecessary medical procedures can be a red flag and allude to fraud.

Witness Statements: Witness testimony is often one of the most influential elements in determining the legitimacy of a claim. Carefully cross-checking witness statements for contradictions or discrepancies is an important aspect of an SIU investigator’s job. If multiple witnesses provide conflicting accounts, it may indicate that the story is fabricated. The investigation of background witnesses, looking for potential connections to the claimant or signs of coordination is called scene investigation.

Dash Cam Footage and Surveillance: Video evidence has become a game-changer in detecting staged accidents. Dashcam footage, traffic cameras, and surveillance video can verify the sequence of events and compare them against the claims being made. Video evidence often uncovers crucial inconsistencies—like how a supposed “accident” was clearly orchestrated by the involved parties.

Vehicle Data: By analyzing vehicle telematics and accident data (speed, braking patterns, airbag deployment), you can determine if the event happened as described. This data can help confirm the legitimacy of the accident or expose deliberate actions.

Claims History and Patterns: The use of advanced data analytics tools to identify patterns in claims data is crucial. For instance, you should look for individuals or companies with a history of multiple claims or claims that follow a similar modus operandi. AI and predictive analytics allow you to flag high-risk claims that may require a deeper investigation.

What Are the Cost and Legal Benefits?

Preventing False Claims: By identifying fraudulent activities early in the claims process, you can prevent false claims from being paid out. This significantly reduces the total cost of claims and protects your company from overpaying.

Reducing Legal Exposure: Staged accidents often result in lengthy legal battles, which can increase your legal expenses. The better evidence you can gather to support your defense in litigation, the quicker the resolution, and potentially lower legal costs. In cases where fraud is proven, it also discourages further legal action from fraudulent claimants.

Lowering Insurance Premiums: The more fraudulent claims your company deals with, the higher your insurance premiums will be. By preventing fraud and uncovering staged accidents, we help keep premiums in check and protect your long-term financial stability.

Improved Risk Management: Our thorough investigations and proactive approach to fraud prevention enable you to manage claims risk more effectively. Armed with accurate and reliable evidence, you can make informed decisions that help avoid the costly consequences of fraudulent claims.

Real-World Examples of an Uncovered Staged Accident?

Many clients have been helped with numerous staged accidents but some of the best case studies are right here for you to review:

The “Double Crash” Staged Accident: In one high-profile case, a trucking company faced a claim where two vehicles were involved in a “collision” that led to significant injury claims. The claimant was a passenger in one vehicle, while the other vehicle was driven by an alleged innocent bystander. The story seemed credible, but our investigators were suspicious. After reviewing dash cam footage, we discovered the vehicles deliberately positioned themselves to create a collision. Surveillance footage revealed coordination between the drivers and a “witness” who provided false statements to support the fraud. With this evidence, the claims were dismissed, saving the client from a potential payout of over $500,000.

Another case involved a small trucking company with multiple claims for “injuries” sustained in minor fender-benders. Upon investigation, it was uncovered that a network collusion between the drivers and a local medical clinic was taking place. The clinic was submitting exaggerated medical bills, and the drivers were being treated for injuries that were inconsistent with the accident reports. Using medical records, witness statements, and vehicle data, fraud was quickly exposed. This not only saved the client significant money on claims payouts but also led to the arrest of several individuals involved in the scheme.

If this information seems of interest to you feel free to reach out to our expert SIU team! Curious for more? Sign up for our upcoming webinars with topics such as Transportation Fraud, AI in Insurance, The Psychology of Fraud, and much more.