Investigative Report Reveals Troubling Behavior in Insurance Fraud Investigations

Investigative Report Reveals Troubling Behavior in Insurance Fraud Investigations

Insurance companies behave in highly questionable ways when investigating their own customers for insurance fraud, a new article on the news site Buzzfeed reveals. The article, titled “Insurance Companies Are Paying Cops To Investigate Their Own Customers,” describes several situations where insurance companies accused their policyholders of crimes— even when they did no more than make routine insurance claims.

Worse yet, the article reveals that some law enforcement officials have delegated the task of prosecuting fraud claims to those companies. Instead of making their own decisions about whether an actual crime has been committed, they allow insurance company investigators and experts to call the shots and gather the evidence.

This is not to say, of course, that real insurance fraud isn’t a problem. People who do things like stage accidents and commit arson to collect insurance money are criminals. Obviously, they should be treated as such. The problem is that insurance companies are casting too broad a net in alleging fraud, ruining the livelihoods or reputations of innocent people. And they’re doing it through an ethically dubious partnership with prosecutors and police which deserves scrutiny.

In most criminal cases, prosecutors act on their own initiative. After receiving police reports, they decide whether to charge a crime. They hire experts on their own to review evidence and reach conclusions to be presented in court.

However, that’s not how all insurance fraud prosecutions work. Insurance companies report alleged fraud to law enforcement and line up the expert witnesses to support the allegations. Those experts sometimes withhold evidence or information that suggests the claim was legitimate. In doing so, they make it difficult or impossible for insurance customers to prove their innocence.

At the same, insurers often provide grants to law enforcement, effectively paying the salaries of law enforcement officers who are going after their policyholders. This cozy arrangement is rife with potential conflicts of interest. However, no laws prevent them. In fact, laws in all 50 states give insurance companies broad protection from legal action brought by customers who might be harmed by wrongful fraud accusations.

Even with good evidence in hand, a customer who has to fight criminal fraud allegations may find the effort ruinously expensive. The temptation to withdraw a claim and go away is enormous for customers who aren’t wealthy. Thus, even when a customer isn’t convicted of criminal fraud, an insurance company can still benefit by ducking the obligation to pay a claim.

Lawmakers and regulators should not turn a blind eye to these practices. While insurance companies should certainly investigate real fraud, they should not be pulling the strings for police and prosecutors to gain a financial advantage.

Buzzfeed deserves credit for bringing these abuses to light. Now it’s up to political and regulatory leaders to take steps to prevent them.

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