Personal Injury Fraud

Personal injury fraud – as it pertains to home, car or business insurance claims – is any act or omission intended to result in a financial insurance benefit for an injury that is nonexistent, exaggerated or unrelated to any accident that would be covered by the policy. No matter what the circumstances, personal injury insurance fraud is a crime.

Personal injury insurance fraud can be “opportunistic” or “premeditated”:

Opportunistic personal injury insurance fraud – most commonly an inflated claim. Examples:

• A health care professional exaggerates the severity of a patient’s legitimate injury in order to increase the claim amount.

• A person who is actually injured exaggerates the extent of his or her injury or required recuperation time. Often such injuries are classified as “malingering.” Assuming that insurance is paying for lost income, the individual may be seeking a “paid vacation” courtesy of the insurer.

Such cases usually necessitate extra medical visits and medical examinations, thus adding to the societal cost of this crime.

Premeditated personal injury insurance fraud – when someone devises a way to make an insurance claim. Premeditated fraud often involves some extreme action. Example:

• A person intentionally causes a car collision or falls down a neighbour’s stairs, and then collect benefits from his or her insurance company for a nonexistent injury.

This kind of fraud also has related financial and human costs, as unsuspecting victims of staged car collisions often suffer very real injuries.