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Red Flags

Bodily Injury, Life and Casualty Claims

Claims procedures are in place for persons who legitimately suffer injury due to motor vehicle accidents, injuries in the workplace, or in daily life situations. Too often, claimants attempt to embellish or create new injuries in order to receive higher dollar settlements. The following "flags" are indicative of suspicion and should be treated with concern.
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The Claimant

• Is difficult to reach.
• Returns calls with a cellular phone or from a telephone number other than their own residence.
• Provides a cellular telephone number or a pager number as their contact telephone.
• Does not provide a permanent residence telephone number.
• Has an unlisted residence telephone number.
• Uses either a post office box or a mail drop as their address.
• Frequently changes their address.
• Provides a parents residence address.
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At times, the charater of the claimant can be
useful toward determining if fraud is involved.

Be aware if the claimant:

• Has an extensive claim history.
• Has relatives with extensive claim histories.
• Has a minor claim but makes major complaints of injury.
• Seeks counsel immediately after the claim is initiated.
• Demonstrates good vocabulary with medical terminologies.
• Appears to abuse substances such as pharmaceuticals, alcohol, steroids or illicit drugs.
• Constantly makes inquiries with reference to the claim status. Expects unrealistic
   settlement amounts.
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Inconsistencies with employment become "flags" if the claimant:

• Is on income assistance.
• Is self employed.
• Is employed on a seasonal basis.
• Is involved in heavy physical labour (i.e.; construction, roofing, landscaping).
• Has income that is inconsistent, leading toward employment relative to a lifestyle.
• Enjoys an income level not compatible with their occupation. Has a poor work history or   questionable employment performance.
• Recently started new employment.
• Is not employed and appears to not have an income source. Advises their employer that they   will be off work for an extended period with little or no professional diagnosis.
• Is employed by a friend or relative.
• Appears to do physical labour that leaves hands dry, dirty or worn (i.e.; dirt or grease under   fingernails).
• Has a high personal debt load.
• Lives a low income lifestyle.
• Embraces quick monetary solutions.
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Once the claim is made, indicators of fraud as it relates
to the injuries claimed for include the following actions.

The claimant:

• Appears physically toned with obvious muscle development.
• Has no visible injuries, examples of claims include fybromyalgia, chronic fatigue, etc.
• Expresses injuries that are subjective (i.e.; headaches, psychological damage or post traumatic   stress disorder).
• Does not report injury complaints at the time of loss.
• Changes injury complaints as the length of the claim progresses.
• Provides inconsistent statements about the cause of injury.
• Provides inconsistent statements about the extent of the injury.
• Refuses an independent medical examination.
• Is reluctant to participate in rehabilitation programs offered by the insurer.
• Advises that they can no longer perform simple tasks.