How Social Media Investigations Assist in Fighting Insurance Fraud

Posted by Veritas Administrators on Feb 8, 2018 2:03:14 PM

Social media investigationLet’s start with a story. There once was a young lady who slipped and fell in a retail store. She alleged multiple injuries, including permanently disabling back issues. Her lawsuit claimed that her life would never be the same, and she sought damages of more than $100,000 from the store.

An enterprising and very smart claims adjuster was skeptical, and rather than ordering costly surveillance on the young lady, who was in college, decided to have an investigative firm examine her activities in the social media landscape.

With access to multiple media sites such as Facebook, Twitter, and Instagram, the social media investigator learned that the horribly injured plaintiff was a college cheerleader, softball player and highly engaged in her sorority – all current activities. Now armed with some interesting intelligence, targeted surveillance was ordered which produced a comprehensive video of the individual’s activities, in full color and including a smiling, very active and very healthy plaintiff.  

When the investigation was shared with the judge, the suit was dismissed. The case ultimately closed for $2,500 in paid medical expenses. The retail store and its carrier were considering criminal prosecution. Happy ending? Not really when you consider the tragedy of someone so young trying to cheat on an insurance claim.

Social Media by the Numbers

There are thousands of stories like this. The Coalition Against Insurance Fraud in North America estimated $80 billion per year in insurance fraud in 2016. 2017 surveys by Insurance Research Council revealed that 24% of Americans believe it’s “ok to pad an insurance claim.”  Insurance fraud has always existed, and it’s not going away.  

But today’s rapidly developing technology makes fraud detection and prevention a much greater reality, and social media investigations play a large role in the evolving landscape.  

There are over 200 well-known social media websites. The top four include Facebook, YouTube, Instagram, and Twitter. There are 2 billion Facebook users for example, and 79% of people who use the internet are on Facebook.  300 hours of video is uploaded to YouTube every minute of the day, with 400 million photos uploaded to Snapchat daily. Amazingly, people using these sites have no concerns about the content or what the content can reveal about their activities. And it’s all public information, there for the world to see.

Social media investigationUsing Social Media as an Investigative Tool

Sophisticated risk managers and adjusters are understanding more clearly the value of detecting fraud using social media investigation. Some leading companies are requiring such investigations on all lost-time Workers’ Compensation claims. Others rely on the red flags adjusters identify to order a social media investigation. However, many companies are understanding that it’s worthwhile to use social media investigation technology to check a claimant’s activity before agreeing to costly and often ineffective surveillance. If activities are identified through social media, targeted, strategic surveillance can be used because investigators know where to look while saving money and getting results.   

When a Facebook post depicts a claimant with a supposed knee injury in a bowling league, complete with pictures of scorecards, including dates and times, it’s not difficult to have an investigator at the bowling alley on league night, video camera in hand to confirm the activities. That’s the kind of material people post on social media. It’s an open book.

Conclusion

Social media investigations are an evolving tool in the fight against insurance fraud. Professional investigators are best equipped to handle this – they have the technology and the expertise that adjusters simply don’t have, along with the contractual obligation to defend clients in case of mistakes. This type of investigation is proving to be a valuable tool in the claim handling process.

The cost is generally a few hundred dollars for a social media investigation. The cost to those who are caught knowingly and willingly committing insurance fraud is much more. 

claim handling

Topics: Workers Compensation General Liability

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