PEDESTRIAN AND INSURANCE

Pedestrian versus auto insurance

Right of Way - Suspect driver appears to give right-of-way to victim driver, usually in an intersection, causing vehicles to collide; suspect later claims no right-of-way was offered. Phantom Vehicle - Solo vehicle crashes due to vehicle of unknown origin/description. Hit and Run - “Hit and run” vehicle strikes victim’s car and leaves scene of the accident. Paper Collision - Parties conspire to create illusion of legitimate accident using either pre-damaged vehicles or by intentionally and covertly inflicting damage on the suspect’s vehicle(s). Generally, law enforcement is not called to the scene of the accident. Organized Ring - Collision orchestrated by organized criminal activity involving attorneys, doctors, other medical professionals, office administrators and/or cappers.Medical Provider - Medical provider inflates billing, knowingly submits bills with improper medical codes and misrepresents facts.
Automobile Property insuranceFaked Damages - Damages to vehicle exaggerated, non-existent, pre-existing or vehicle damaged at a later point in time. Inflated Damages - Damages inflated or exaggerated, non-existent or pre-existing; excessive billing of vehicle body parts or repair work. Vehicle Theft - Vehicle or motor home theft.Vehicle Arson - Vehicle or motor home arson.Auto Property/Vandalism - Vehicle or motor home vandalism including such items as car rims, stereo equipment and engine parts.Agent/Broker - Policy backdated prior to loss date and/or theft of premium dollars intended for payment of coverage.Embezzlement - Embezzlement of funds.Trailered Watercraft/Theft Damage - Watercraft stolen or damaged while being transported on trailer. Trailered Watercraft Arson - Arson of a watercraft while transported on trailer.Other Auto Property - Any other auto-related circumstance not listed above involving the presentation of false documents as proof of insurance.
Medical insuranceSlip & Fall - Suspicious slip/fall claim.
Inflated Billing insurance - Inflated billing by any medical facility, doctor, chiropractor, laboratory, etc.Disability - Disability claim submitted against disability insurance policy while claimant on permanent or temporary disability and receiving continual benefits and/or vocational benefits and/or claimant reported working or performing activities exceeding alleged physical limitations.
Food Contamination insurance - Foreign object found within food/drink products. Pharmacy - Pharmacist or pharmacy inflates bills or falsifies billing; person illegally obtains medical prescriptions and submits prescriptions for habitual need. Dental - Dentist or dental office inflates bills or falsifies billing codes.Embezzlement - Embezzlement of funds.Other Medical - Non-auto injury reported by insured and/or claimant; medical assistance was reported.
LifeQuestionable Death - Questionable circumstances surrounding reported death; staged death/false identity.
Suspicious/False Policy Application - Suspicious or questionable actions by applicant or policyholder; potential for monetary gain from life insurance policy. Include suspicious claims involving murder for profit and claims pertaining to viatical settlements.
Workers' Compensation Claimant Fraud - Suspicious employee applicant claim.Employer Defrauding Employee - Employer committing illegal act against employee(s).Legal Provider - Legal provider inflates billing or materially misrepresents the facts. Medical Provider - Medical provider inflates billing, knowingly submits bills with improper medical codes and misrepresents facts. Pharmacy - Pharmacy inflates bills or falsifies codes. Misclassification - Misclassifying the type of workers to obtain workers’ compensation coverage at a lower premium. Under Reported Wages - Misrepresenting payroll to obtain workers’ compensation coverage at a lower premium. X-Mod Evasion - Misrepresenting claims history by not reporting reportable injuries or by creating shell companies to give the impression of a non or low claims history to obtain workers’ compensation coverage at a lower premium.Embezzlement - Embezzlement of funds.Uninsured Employer - Uninsured Employers.
Fire insuranceCommercial Fire - Suspicious commercial/business fire damage.Arson for Hire - Suspected arson for hire.Residential Fire - Suspicious residential fire damage.Inflated Fire Loss - Inflated claims from fire loss.
Property insurance Theft Residential - Suspicious residential theft.Theft Commercial - Suspicious commercial business theft.Theft Commercial Carrier - Insured reports baggage/cargo lost by commercial carrier.Watercraft/Aircraft Theft - Theft or damage to watercraft/aircraft while not on a trailer.Watercraft/Aircraft Arson - Arson of watercraft/aircraft while not on a trailer.Vandalism - Vandalism or malicious mischief to the interior or exterior of business or residence.Property Theft from Vehicle - Suspicious theft of personal property while stored in a vehicle or motor home.Agent/Broker - Policy backdated prior to loss date and/or theft of premium dollars intended for payment of coverage.Mold Related - Mold related.Other Property Damage - Property damage not included in other definitions.
Healthcare insuranceEmbezzlement - Embezzlement of funds.Identity Theft - Using another’s identity to secure health care benefits.Unlawful Solicitations/Referral - Denotes cases where patients are recruited and given incentives to undergo medical procedures, whether those procedures were actually performed or not.Billing Fraud - Medical provider knowingly submits false medical bills by billing for services not rendered, billing for wrong procedure codes or billing for procedures of a medical necessity when procedures may have been elective or cosmetic in nature and not covered by health insurance.
Immunization Fraud - False billings by medical providers for immunizations that were not given.Pharmacy - Pharmacy inflates bills or falsifies codes.Surgery Center Fraud - Any alleged fraudulent activity pertaining to outpatient surgery centers.Disability - Disability claim submitted against disability insurance policy while claimant on permanent or temporary disability and receiving continual benefits and/or vocational benefits and/or claimant reported working or performing activities exceeding alleged physical limitations.