False insurance claims cost American consumers $80 billion annually, with fraudulent cases reaching an all-time high.
The staggering cost of investigating claims not only leads to higher premiums for honest customers, but also has a costly impact on insurers’ attempting to deal with sincere claims efficiently.
Fraud is as old as insurance itself, however with the rise of digitization, so too has the sophistication of fraudsters evolved. They look to the complexity of the claims in order to go undetected and have become skilled in harvesting genuine customer information for account claim takeovers or exaggerated loss reporting.
In the wake of COVID-19, insurance companies have had to deal with increased counterfeit insurance claims, including collusion claims, double claiming and phantom claims. According to Forbes:
"Some industry professionals believe the number of claims with some element of fraud has nearly doubled since the COVID-19 pandemic.”
This costly issue has forced insurance companies to develop new methods and tactics when investigating claims in order to stay one step ahead of fraudsters.
In addition to uncovering previous convictions, checking financial records, poring over historical claims, conducting interviews with claimants and witnesses, and performing statistical data analysis, social media now plays a vital role in validating claims.
With an array of photos, videos, and tweets available online and users’ digital footprints growing exponentially, adjusters can use social media screening to discover red flags easily and unveil potential insurance fraud.
With a mountain of publicly available and discoverable data online, how exactly does social media provide a unique insight into validating/denying insurance claims?
Let’s explore further.
How Can Social Media Data Help Insurance Claims Investigations?
Data and technology play a vital role in combatting fraudulent claims, providing unique insight that may not otherwise be available through traditional channels, especially considering that 82% of the United States population has at least one social networking profile, and the average American has seven of them.
Social media can provide a wealth of information that can sometimes help adjusters identify whether a claim is valid or not, or at least steer them in the right direction. This is because social media is:
- Self-reported – Data uncovered through social media screening is primarily provided by the source themselves. While it’s essential to verify their identity to avoid false positives, the information that is found on these platforms is more valuable as it comes directly from the person being investigated.
- Up-to-date information – Images and videos can be found on people’s feeds, offering insight into their recent activities.
- Led by emotion – Humans are social creatures, and posting on social media is driven by two factors, status, and emotion, with many people regretting their posts afterward. This is often unfiltered information they wouldn’t readily disclose on record.
Let’s take a closer look at various insurance claims and how social media investigations can help detect evolving fake claims and protect honest customers.
Personal Injury Claim
Some people see a small puddle in grocery stores without a caution sign and decide to take advantage of the situation or even throw a few grapes on the floor, pretending to take a fall and make a fast buck.
This was the case with a claimant, Sarah, a passenger in a vehicle that had an accident with another car while changing lanes. Sarah alleged that she had gotten injured and said she experienced pain for six months in her shoulder and neck which prohibited her from completing daily tasks like exercising, lifting, and brushing her hair.
Although she experienced such pain, Sarah never sought medical attention for her ailments, which was suspicious to adjusters investigating her claims. A quick social media screening showed Sarah posting scuba diving and snowboarding photos of her and her friends. With the evidence gathered and presented in court, Sarah’s claims were dismissed.
Even if the person in question doesn’t use social media, they can still get tagged in photos by their friends or family members that the insurance company can use as proof against them if they’re exaggerating the extent of their bodily injuries.
Medical Injury Claim
Unethical practitioners can work together with scheming patients to collect claims. An example is where parents claimed their child was born with a permanent injury that kept them from being fully mobile.
Suspicious claims adjusters decided to look into the social media platforms of the parents. They found proud videos of the child claiming first prize in the sports day races, saving the insurance from yet another fraudulent claim.
When it comes to automobile insurance, Value Penguin reports that “more than one-fifth of drivers lied to their insurer. 22% admit to lying to their auto insurer, most commonly by claiming damage to their vehicle but then pocketing the money intended for repairs, or by lying about their address or number of drivers to get a cheaper premium.”
Millions of people have car accidents, some resulting in life-changing and costly injuries. One of the primary causes of vehicle accidents is the unlawful use of cell phones. If posts on social media were published at the time or before the accident, they could be used as evidence of negligent driving.
Even if those images, videos, or comments are later deleted from social media by the perpetrator, metadata from those posts can be uncovered, including timestamps.
Property Damage Claim
In terms of break-ins, it’s challenging to know what property has been stolen and what wasn’t, with some people attempting to stretch the truth and add a few more items to the list, including televisions or laptops.
Those same items might be seen in the background of social media posts after the alleged break-in, which can help claims adjusters determine whether the claimant is being truthful or not.
Another example sees a man claiming that his bathroom had flooded, ramping up quite the plumbing bill, with many parts that needed to be changed. Although the claimant produced receipts for most of those parts, it was later discovered that the plumber in question was a cousin of the claimant and had produced copies of previous receipts.
Workers’ Compensation Claim
Machinery accidents, falling, overexertion, slips and falls, workplace violence, and being struck by an object are all common claims when it comes to workers’ compensation claims.
While some of these accidents can be incredibly painful, they can also be caused by workers attempting to cut corners or failing to wear hard hats (in factories or construction sites).
As people tend to overshare on social media, images, videos, or boomerangs will most likely find their way to these platforms at one stage or another. Claims processors can see information showing whether employees tend to follow occupational health and safety rules or not.
With that essential information, it’s much easier to conduct an interview with other witnesses and find out what truly happened on site.
Organized Insurance Fraud
Organized insurance fraud rings can mean big business, stealing millions of dollars in their wake. In addition, this type of fraud network is far-reaching, often across multiple state lines and with plenty of connections.
These savvy criminals stage injuries and fake car crashes and work with unethical medical providers to achieve their unlawful objectives. While claims adjusters might be suspicious about particular individuals, they may not be able to find their connections through traditional channels.
A sneaky photo tag of a celebratory night out with “the gang” can shed much light and information on the bigger picture.
One family made millions from insurance companies by staging crashes, whiplash injuries, and repairs that simply never happened. They played the system and went under the radar for years simply due to the 83 people they roped into their ring.
Fortunately, Facebook brought the scam to life with wedding pictures showing as many as nine people supposedly not connected at the same wedding ceremony, posing with the bride and groom, who were found guilty of involvement in around 30 claims.
81 of those people were found guilty of conspiracy to defraud, while two were prosecuted for theft.
To streamline their claims review process and uncover fraudulent claims more efficiently, adjusters use various investigation and screening methods. In recent years, social media screening has become a valuable and much sought-after service by many insurance carriers, SIU departments, risk managers and private investigators.
Social media investigations can be a valuable tool in virtually any claims investigation process, including worker’s comp, auto accident, property damage and even organized insurance crime.
Get in touch today to find out more about social media screening and how Social Discovery can help.