Insurance Fraud Article

There are many things insured people in Cleburne, Granbury, Aledo, Burleson, Keene, Joshua, Wylie, Roanoke, Keller, Colleyville, and the major cities, like Dallas, Fort Worth, and others need to be aware of as it relates to applying for, or receiving benefits from an insurance policy. A good example of this is found in an article written by Shan Li in the Los Angeles Times.
The article was published on January 25, 2011, and is titled, “Insurers Are Scouring Social Media For Evidence Of Fraud.” Much of the content of the article is included here and is a good read for “one of those things consumers need to be aware of.”
The internet social network sites such as Facebook and Twitter are great sources of information and fun and communication between relatives and friends. One downside to these sites is that other people can find out things that you may not want being public. But as the article tells us, now there’s another reason to be careful about what you post on Facebook and Twitter: “Your insurance company may be watching.”
One lady has found this out the hard way.
The, un-named here, person was struggling with depression. She is a 30 year old from Quebec, Canada, who took a medical leave in 2008 from her job as a technician. Soon after, she began receiving monthly disability benefits from her insurance company, Manulife Financial Corp. But, a year later the payments stopped.
A representative of the Toronto insurance company told her that Manulife used photos of her on Facebook — showing her frolicking at a beach and hanging out at a pub — to determine she was depression free and able to work.
This lady’s attorney says the insurance company just assumed from the pictures that she was a fraud without further investigating before terminating the benefits.
Manulife was sued, accusing them of failing to talk to her doctor and neglecting to inform her before cutting off payments. The case is set for trial in a year.
The insurance company, Manulife, is saying: “We would not deny or terminate a valid claim solely based on information published on websites such as Facebook.”
What is important for the consumer to know here is that such sites have become the latest tools in detecting fraud, which the insurance industry says costs the United States as much as $80 billion a year and accouts for 3% to 10% of total annual healthcare spending.
A spokesman for the National Insurance Crime Bureau, Frank Scafidi, says that investigators who once followed people with cameras now sit behind desks “mining databases and searching Facebook. They look out for things that don’t add up, like someone claiming they hurt their back too badly to work and then bragged on Facebook about running a marathon.”
These social network sites have become such “standard tools” that Peter Foley, vice president of claims administration at American Insurance Association, said that investigators could be considered negligent if they didn’t conduct at least “a quick scan of social media to check for contradictions.” He also pointed out though, that the evidence gathered on these sites should be used only as a launch pad for further investigations and never as final proof of fraud.
Some insurance companies are even exploring using online data to help underwrite policies. In this regard, Celent, the insurance consulting arm of financial and insurance brokerage firm, Marsh & McLennan Cos., recently published a study titled “Leveraging Social Networks: An In-Depth View for Insurers” and suggested that social-networking data could be used to help price policies.
A Celent senior analyst said life insurance companies could find social media especially valuable for comparing what people will admit about lifestyle choices and medical histories in applications, and what they reveal online. This could range from “liking” a cancer support group online to signs of high-risk behavior. “If someone claims they don’t go sky diving often, but it clearly indicates on their online profile that they do it every weekend they can get away, that would raise a red flag for insurers.”
The situation is coming up more and more in court where the lawyers for insurance companies lay traps for the insured person based on pictures or postings on Facebook or Twitter. This author has seen this in court cases.
The problem for the insurance company is that if they don’t do a proper follow-up investigation based on what they have found online, they are setting themselves up for a big lawsuit. What happens often is that the photos can be years old, people are writing things in jest or joking, or maybe just fantasizing a bit.
Insurance company lawyers will use anything they can find on these sites to make the insured look bad, photos of you drinking, photos of tatoos, maybe some vulgar language or racy language. The intent is to just make the person look bad in an effort to bolster the case of the insurance company.
What happens on these sites many times is that a person tries to picture themselves in what they believe is their best light, to seem “cool” and to appear to be having a great time in life. They do not post pictures of themselves crying in pain or sitting lonely by themselves because they are unable to do anything else as the result of some bad event that an insurance claim is based on.
The bottom line is for consumers to be aware of how these social network sites can be used in a negative way by insurance companies. Just being aware of this will take care of a lot of the problems that might result. Seeing an experienced Insurance Law Attorney if you find yourself the victim of what has been posted being used against you, can go a long way toward getting the situation resolved in a favorable way.