“According to the Insurance Information Institute, fraudulent claims add $30 billion of annual cost to the property/casualty insurance market. This is an enormous burden to the economy, the industry, and most importantly, the consumers,” said Steve Rich, CPCU, AIC, Vice President of Claims, Acadia Insurance. “In the end, we all pay for it because fraud creates higher insurance premiums for everyone.”
“To combat insurance fraud, Acadia’s Special Investigation Unit (SIU) focuses on fraud awareness, fraud identification and on investigating the suspicious claims”, Rich added.
In response to a worker’s compensation suit in Maine which resulted in Acadia Insurance receiving a $6,000 restitution payment, the company offers some insight into and tips on how to help detect worker’s compensation fraud.
- Acadia’s local claim representatives are trained to flag claims as potentially fraudulent when certain characteristics exist.
- These claims are referred to SIU where the decision for further investigation is made.
- As a result of its efforts, the Unit helps mitigate the cost of fraud by identifying the fraudulent cases, denying the appropriate claims, seeking restitution on claims paid, and pursuing criminal prosecution for offenders.
- In general, employers should adopt an effective safety-management program to avoid workplace accidents in the first place.
- Employers, together with their insurance carrier, should work with medical providers to flag suspicious activity in the return-to-work process.
- Employers and carriers should collaborate with state and law enforcement agencies to track down those committing fraud and be willing to prosecute the offenders.
- Employers should partner with carriers that have experienced special investigation units, which have the tools, means and networks to determine and investigate fraud.
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