The 2010-2011 NFL season has officially wrapped up, and players now have time to heal their bodies from the blunt forces and injuries incurred throughout the season. These hits to the head, back, neck, and side are often exponentially harder than many auto accidents, yet each year millions of dollars are paid out to compensate people for even the slightest fender bender.
Having investigated auto accidents for a number of years, I’m often amazed to see people walk away from totaled vehicles, rollovers, and head-on collisions with just a few bumps and bruises, while others claim injuries when there is no visible damage to their cars.
Is it fraud? Is it possible to be injured in an accident with no visible property damage? The answer to both could be either yes, no, or depends. Most certainly insurance fraud is an issue that plagues our society, costing the average family between $400 and $700 dollars per year, according to the FBI.
Fraud comes in all shapes and sizes, from a staged accident to a person claiming to be hurt when they really weren’t. According to the Insurance Research Council, more than one third of all accidents involve claims for opportunistic fraud. Many of these claims involve low-impact accidents.
So what is an insurer to do when a person files a claim for injuries, yet there is little-to-no property damage? Exactly what should be done with any claim: Investigate, investigate, investigate.
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The very fundamentals of a proper claims investigation are driven by simple blocking and tackling maneuvers that will drive quality and results. A cornerstone of an investigation must include photos and measurements of both vehicles, as it is possible to have significant damage to one car and virtually none to the other. For example, a Ford Focus that rear-ended a full-size Chevy pickup would under ride the truck, resulting in extensive front-end damage to the Ford and virtually no rear-end damage to the Chevy.
Measurements are critical as well, as these can not only validate that the two cars indeed struck one another, but also can provide a biomechanical engineer with critical data when determining velocity and resultant G-Forces exerted on the occupants who are claiming injury.
Statements should be taken from all parties, including any witnesses. Particular detail should be paid to not only the accident but also any conversation or comments that may have followed, which can be indicators of opportunism. Consider the situation in which the person claiming injury grabbed their neck and said, “I better call my lawyer.”
A thorough investigation will also include a detailed investigation into medical history. Did the party claiming to be hurt have a history of claims? Have they been in multiple accidents? Is there a pattern of claiming injury only when they aren’t at fault? Were there pre-existing conditions or intervening circumstances? What was their pattern of treatment? What was said to their medical provider?
By obtaining 10-20 years of medical history, either through a voluntary medical release or discovery, critical clues can be unearthed to either validate or refute what a party is claiming.
Video surveillance, hospital checks in metropolitan areas of all known prior residences, and canvassing of neighbors, co-workers, and especially ex-spouses also provides valuable insight into claims that may be presented.
Lastly, a biomechanical engineer can review your case, or even the vehicles, and provide an estimation of the speed at the time of impact and the likelihood of injuries based upon statistically valid sampling of accident victims from similar situations. However, you should keep in mind that they will not be able to say with 100 percent certainty that a person was or was not injured; they can only attest to the probability, which makes it that much more critical to meet the injured party and their attorney to assess credibility and witness potential.
Companies have adapted a wide variety of approaches to investigating low-impact claims, ranging from aggressively fighting them to utilizing software applications to assist in gauging velocity and force on the occupants. The reality is that there is no one size fits all, as every case must be evaluated upon its merits, with all evidence being considered. While there is generally a correlation between force and injury, there are exceptions to the rule, albeit on rare occasions.
When implementing processes to maximize your internal efficiencies and accuracy of settlement, you should consider your approach to low-impact claims handling, with particular attention paid to steps that should be taken during the investigation. Handling these types of claims takes training, just like any other claim. When they are properly investigated, it can have a significant impact on the bottom line.