|
|
|
|
 Insurance
Claim Investigation Services: Case StudiesI
Created Him. I Can Kill Him
Two US-based
insurance companies were each provided claims on life
policies purchased for a now deceased 27 year old
man. The claims were both made by the brother of the
deceased and involved significant policy amounts.
The claimant, through his attorney, provided documentation
indicating the insured had died as the result of injuries
sustained in a traffic collision occuring in Costa
Rica. Through his attorney, the claimant pushed both
companies to complete their processing and pay the
claims immediately. One company prepared to pay their
claim, finding no issues of concern as the result
of their investigation. The second company, our client,
referred the matter to both state and federal authorities
for criminal prosecution when our investigation revealed:
- Information provided
on the application and contained in documentation
submitted with the claim indicated both the beneficiary
and the insured shared the same national identification
number, date of birth and place of birth. IRI's
investigation revealed no documentation on file
of the birth of the insured, only the beneficiary.
Investigation also revealed the name of the insured
was actually the name of the father of the beneficiary.
-
Before
his untimely passing, the insured made several
applications for consumer credit, including a
federally subsidized home loan which was approved,
funded and insured.
-
Interestingly,
the beneficiary had an extensive adverse driving
history and his license had been suspended. Shortly
thereafter, the insured obtained his first driver's
license in the United States. The physical descriptions
and driving histories of these two license holders
were virtually identical.
-
The
Social Security number provided for the insured
was never issued by the U. S. Social Security
Administration.
-
The
provided Certificate of Death was never issued
by the government of Costa Rica. It was, instead,
a well-crafted, computer generated counterfeit
document based on an existing certificate. One
clue, the registration number, indicated that
941,315 people (nearly 1/3 of the country's total
population) had died in Costa Rica in a period
of 57 days.
On
Second Thought
A life claim
examiner assigned an international claim investigation
to a large, well known competitor. After considerable
delay and repeated status queries by the examiner,
the competitor completed their investigation and provided
a report which indicated verification of the facts
provided with the claim.
Relying
on this report, the company would pay a $1M policy
within the contestable period.
The examiner's instincts
told her to take another look at the circumstances
of the claim. She sought additional advise and soon
hired IRI. Conducting fundamental investigation,
IRI investigators established the claim contained
numerous misrepresentations and discovered the insured
was under criminal indictment at the time of the
policy application. Based on our report and other
important factors, the policy was rescinded.
Contact
a representative online or at (800) 252-5853 to
learn more about Investigative Resources International's
ability to support your insurance company's operations
- worldwide.
|
|
|
