Short Term Insurance Claim Investigations

Short Term Insurance Claim Investigations

Uphando provides specialised services to the short term insurance industry. These services include the investigation of all suspicious, disputed, fraudulent or suspected fraudulent claims. Our experience in the different sectors of the short term insurance industry inter alia includes personal lines, commercial lines, including fleets and financial markets.

Insurance fraud

Insurance fraud has existed since the beginning of insurance as a commercial enterprise. The types of insurance fraud are diverse and occur in all areas of insurance.

Insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due.

Theft / Hijacking

The constant increase in motor vehicle claims, including LDV’s and HDV’s, due to theft or hijacking, has compelled us to develop a clear understanding of the challenges faced by insurers to assess these claims. We adopted a process whereby such claims are investigated two folded, namely, to ensure that the policy conditions are correctly interpreted and adhered too, and to ensure that the merits of the loss are clearly reported on.

Motor Vehicle Accident

South Africa has one of the highest road accident rates in the world, with around 25% of those accidents caused by cellphone use while driving. Road accidents may result in injury, death and property damage, and the cost of this in human tragedy is enormous. Alcohol, speeding and distracted driving are the three biggest causes of road accidents in South Africa.

Motor vehicle insurance scams victimise law-abiding drivers by creating blemished driving records, legal headaches and higher premiums. Insurance companies also end up paying out millions of Rands each year to settle claims that aren’t real, but easy to float due to the after-the-fact reporting nature of motor vehicle accidents. Most cons are performed by professionals who run rehearsals before really committing the crime. They are usually very skilled at their trade, but that does not mean you can’t take steps to prevent yourself from becoming a victim.

So, what can you do to help yourself and all the other honest insurance premium payers? First, learn about the most common car accident traps carried out today. If you think you’ve witnessed a scam or are being scammed, contact you insurance provider immediately.

The most common car insurance scams are:

– The “swoop”: There is a law that states that if a driver rear-ends a car in front of him/her, it is always the driver who is at fault. Scammers often take full advantage of this fact. The scammer takes note of any small gaps in traffic and swoops into another lane, making it nearly impossible for the other vehicle to stop to avoid a collision.
– The “hit and run”: This is occasionally done on purpose and sometimes in an effort to conceal what really happened in the event of an accident. This occurs when a driver damages his/her vehicle and then claims that the accident was caused by another vehicle that fled the scene after the fact.
– The “wave in”: We are often grateful to courteous drivers who allow us to cross a busy street or who let us into a lane when traffic is heavy. Unfortunately, some scammers do this in an effort to cause an accident and collect insurance money, claiming that they did not “wave you in” in the first place.
– The “sideswipe”: Be mindful when there are two turning lanes. A scammer in this situation may drift into your lane intentionally, resulting in a sideswipe accident and then insist that you were the one doing the drifting,
since it can be difficult to prove either way.
– The “fake injury claim” or “phantom victim”: This can happen in any kind of accident, not just rear-endings. Say you get in a fender-bender, and the other driver immediately reports back pain, “whiplash” or other injuries. If the driver seeks hospitalization, he’ll file an insurance claim with your insurance company to cover the expense, even if it’s bogus. Whether an after-effect of a staged accident or a cash ploy that comes later, the scammer will attempt to file claims for additional passengers in the car, claiming pain or injury, even if no one else was present. (It’s especially easy for scammers to try this with online claim filings.)

Insurance investigations claims advice

At Uphando we go the extra mile in order to ensure that we obtain positive results in respect of the tracing of third parties. The team strive to verify all necessary details in order to proceed with a recovery. We offer our service to assist with numerous claims related documents in order for our clients to process and finalise a claim. We are able to obtain the following:

– Accident Reports and/or police report

– CIPC verification to determine the registration of an entity and who the Directors are

– Consumer Trace Report to ascertain the financial status of an individual for the purpose of recovery

– Driver’s Licence and/or PDP Licence verification

– eNatis to determine registered ownership of a vehicle

– Tracing of Third Parties