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Fighting for Injured Workers Throughout the Central Valley

Plaintiff Fraud – Inconsistency, Witnesses

Situations In Which An Adjuster Will Suspect Fraud In A Personal Injury Caseman in a sling and neck brace being treated by a doctor

Our clients often have questions as to what will make an insurance claims adjuster suspect fraud might be occurring.

Examples of Situations That Could Be Suspicious To an Insurer

  • There are inconsistencies in how the incident occurred. When the claimant describes what happened and is inconsistent with the details, changes the story after the fact, or if another individual gives misrepresentations or fabrications, the adjuster will look more closely at the case to check its validity.
  • There are few or no witnesses. An adjuster will be skeptical if he or she can’t find any witnesses to the incident. If there is a witness and the description of the accident is different from what the claimant and other witnesses said or if witnesses are suddenly found the date of the trial, it’s a red flag that fraud might be in play.
  • The accident was reported late. If the accident isn’t reported in short order after it happened, it could be seen as unusual in the eyes of the adjuster. The longer a claimant waits from the time of the accident to the first time medical treatment is sought, the more suspicious the insurance company is likely to be.
  • Receiving notification that an attorney has been hired. In the event that an attorney is hired, the adjuster will look at the date. If it is the same day or a day or two later after the accident, the adjuster will question the timing and wonder if something improper is going on.

If you have questions about what will raise the eyebrows of an insurance claims adjuster and lead to the suspicion of fraud, an attorney can help. Call the Law Offices of Rancaño & Rancaño at (916) 884-6554 today.