Auto give ups, stolen vehicles, arson, padded injuries, inflatedmedical bills, drug diversions, and disability exaggerations arejust a few of the scams that play out in the insurance arenadaily.

According to the Insurance Research Council (IRC), one in threeAmericans believes it is acceptable to inflate a claim to pad adeductible. One in four believes it is acceptable to do this inorder to recoup previously paid premiums.

The reality is that each and every day insurers are faced withsituations that are outright fraud or contain elements of fraud. Infact, it is estimated that 21 to 36 percent of insurance claimscontain an element of fraud. The continuing poor economicconditions complicate matters, creating a financial motive for manywho would never consider such drastic action in “good times.”

The Bad Apples

So how can insurers, who are charged with accurately resolvingclaims in a timely manner, discern the good from the bad? How canclaims adjusters, often doing more work with fewer resources, take the time toproperly identify and investigate claims containing “red flags,” orpossible indicators of fraud?

On the surface, this may seem like an insurmountabletask. Fortunately, however, there are steps insurerscan take to tackle this dilemma. First and foremost, do not goit alone. Gone are the days when we got into our company cars andhit the streets to look for clues to unravel the mystery behind theclaim. While this may have been the optimal way to handle claims ageneration ago, these investigations can be performed moreexpeditiously by leveraging available technology, such as linkanalysis and indexing information.

Of course, it doesn't hurt to have feet on the street either.Having the ability to canvass for witnesses, inspect sometimesnon-existent clinics, measure vehicular damage, and take claimantstatements in the presence of their attorney can provideinvaluable insight into an investigation. When used in conjunctionwith modern technology, this approach can often make or breaka case.

While digging for dirt is imperative, digging deeper is whatseparates the great adjuster, manager, and executive from thetypical. In my experience, I have witnessed the entirespectrum from failure to mediocrity to greatness, and at the latterend, there are common bonds of confidence, determination, and aninsatiable curiosity to dig deep and find answers.

Curiosity Fosters Greatness

Great adjusters become great because they ask a lot ofquestions throughout the claims process. They ask questions notonly of parties to a claim but of management. Often it is thesevery people who become great managers and eventually executivesbecause they ask the difficult questions.

But what exactly sets the great apart from the mediocre? Oftenit is intuition, such as that of Barton Keyes, a claimsinvestigator in the thriller Double Indemnity. In themovie, Keyes talked of an internal knack or hunch referred to ashis “little man.” It was through these hunches that he was able toseparate the good claims from the bad every day, and in the moviehe solved a murder-for-insurance plot.

A claims professional must follow his or her gut, as it rarelyis wrong. If something doesn't seem right with a claim, then itvery well may not be. The key is to differentiate between theobjective and subjective, which distinguishes between the ordinaryand extraordinary.

As discussed in Re-Adjusted: 20 Essential Rules To Take YourClaims Organization From Ordinary To Extraordinary, greatadjusters take the time to dig deeper. They will not only askquestions from the parties to the claim, but will also lookfor discrepancies. They will inquire about the claimant's medicaltreatment and also obtain physical descriptions of the pertinentclinics and providers.

Great adjusters will ask for directions from the home tothe chiropractor's office. They will measure the damages and lookfor metal striations and paint transfers. The list of what the“great” adjuster will do goes on and on. At the end of theday, this investigative work may show that anordinary claim was actually staged.

Adjusters will then leverage available technology to search forprior claims and analyze associations between the claimants,medical providers, and attorneys. They will look for key patternsor connections, which in turn can point to larger, moreorganized activity.

While many organizations are scaling back on manpower for avariety of reasons, it is important to recognize that thisincreased demand on productivity can take a toll on investigativecapacity. By leveraging credible and experienced external businesspartners, insurers can maintain a competitive advantage. A varietyof such partners can provide investigative resources, forensics,accident reconstruction, and demographic information foradjusters to utilize throughout the course of their variousclaims investigations.

There are also a number of free resources available tocomputer-savvy adjusters wanting to dig a little deeper on theirown. The following is a list of websites that provide a wealth ofinformation that can be used in conjunction with state- andcounty-specific websites to verify personal information,property ownership, and professional licensure of medical and legalproviders:

Skip Tracing Websites and Resources

www.spokeo.com

www.411.com

www.pipl.com

www.anywho.com

Social Networking Sites

www.facebook.com

www.myspace.com

www.linkedincom

www.plaxo.com

Real Property, Asset and Liens

www.earth.google.com

www.salary.com

www.zillow.com

Government Resources

www.cms.gov

www.dol.gov

www.noaa.gov

www.nhtsa.gov