Private Investigator: Insurance Fraud Investigation

Did you know that the total cost of insurance fraud in the United States is approximately $40 billion/year? That’s crazy, right? But, it’s true. Employees make a huge chunk of it as they may put up fraudulent claims to get compensation for injuries and losses that they may never have incurred.

Insurance fraud investigation by a PI can find evidence to fight baseless or exaggerated claims and protect the interests of the insurance company from people seeking easy money.

If you suspect your company is facing fraudulent claims, Upstate Private Investigators can help you uncover insurance fraud and dishonest employees. Our private investigation agency serves clients in Greenville, Anderson, and the Upstate South Carolina region.

Types of Insurance Fraud Investigations

Insurance fraud is illegal, and this crime can cost insurance companies millions. This leads to higher premiums for policyholders. An experienced team will use a variety of tools to search for evidence of fraud and cooperate with law enforcement agencies to make sure the guilty parties face justice.

Health Insurance Fraud Investigation

Health insurance fraud involves claimants submitting false or exaggerated claims to receive unwarranted benefits. This type of fraud can include fake medical bills, unnecessary treatments, or claims for services not rendered. Private investigators help insurers by analyzing billing records for inconsistencies and conducting surveillance on claimants to confirm they are genuinely injured or ill.

By gathering solid evidence, PIs can expose fraudulent claims and save insurance companies significant amounts in unwarranted payouts.

Car Insurance Fraud Investigation

Car insurance fraud encompasses various schemes, including staged accidents, inflated repair bills, and false claims of vehicle theft. Private investigators work to find the truth by examining accident scenes, analyzing vehicle damage, and interviewing witnesses. They may also conduct surveillance on policyholders to verify the legitimacy of their injury claims.

Through meticulous investigation, PIs can reveal inconsistencies in claimants’ stories and provide insurers with the necessary evidence to dispute fraudulent car insurance claims.

Home Insurance Fraud Investigation

Home insurance fraud occurs when policyholders exaggerate or fabricate damages to their property to receive higher payouts. This can include arson, staged burglaries, or falsely claimed water damage.

Private investigators assist by inspecting the property, analyzing the cause of damage, and identifying signs of intentional harm. They may also interview neighbors and other witnesses to gather more information. By collecting comprehensive evidence, PIs help insurance companies deny fraudulent home insurance claims and maintain the integrity of their coverage.

Workers’ Compensation Fraud Investigation

Worker’s compensation laws allow employees to receive benefits for workplace injuries and occupational illnesses. Many employees can make false claims to get money from insurance companies. These false claims can pass the eyes of the accounts and the HR department and cause monetary loss to your business.

It is important for employers to conduct audits and get help from a private investigation firm to prevent these losses.

Life Insurance Fraud Investigation

Insurance fraud investigations can reveal attempts to obtain life insurance when a person is not deceased and claimants using deception to inflate benefits. Private investigators can help verify the death of the insured, investigate the circumstances surrounding the death, and expose any fraudulent activity.

Insurance Fraud Investigation

How Do Private Investigators Uncover Insurance Fraud?

PIs use a variety of tools and techniques in insurance fraud investigations.

Go Undercover

A private investigator can go undercover and act as a company appointment security manager. The goal is to identify the loopholes in your policy and asset protection and help you proactively deter fraudulent insurance claims and theft.

Loss Prevention Audit

Private investigators audit each department to determine if there are any security lapses and process loopholes that may lead to false insurance claims and theft. We will then put the required security control methods and procedures in place.

Use Surveillance

If you suspect a specific employee or a group of employees of committing insurance fraud, a private detective can use surveillance methods to keep track of their movements and find proof of fraudulent behavior.

Private investigation firms may make use of audio, video, and GPS tracking on company property. PIs understand the laws governing surveillance and will use their expertise to protect your business.

Background Checks

Background checks as a critical tool when investigating insurance fraud. These checks help uncover relevant information about the claimants, such as previous claims, past accidents, criminal history, and more.

Social Media Posts

Private investigators often use social media posts to find evidence of false insurance claims. For instance, a person claiming to be severely injured in an accident might post images of themselves playing sports or attending social events. This type of evidence can be used to deny illegitimate payouts.

Other Techniques

Here are some other steps that your private investigator may take to detect fraud:

  • Do a careful and thorough review of insurance documents.
  • Do investigative research into the claim.
  • Interview the claimant and witnesses.

What Will a Private Investigator Need From You?

Private investigators need access to crucial information such as security footage and records to obtain evidence. They may need to conduct in-depth business investigations, surveillance, employee investigations, etc.

Your private investigator will do a deep dive into the situation and identify the guilty parties. If the case is taken to court, we will ensure that you have all the proof necessary to make your case. Our team will cooperate with law enforcement and support your company in resolving the matter.

How Can Upstate Private Investigators Help?

At Upstate Private Investigators, we have over 25 years of experience in private investigations in South Carolina. We not only uncover insurance fraud but also help your organization put processes and measures in place to deter such behavior in the future. Our services include:

  • Risk, threat, and vulnerability assessment
  • Designing security systems
  • Setting up toll-free numbers for employees to report fraud
  • And more.

We have a team of licensed private investigators who get the job done quickly. We are available for you 24/7 to ensure the quickest resolution of your problem. We are dedicated to handling these sensitive matters with the utmost attention and expertise.

If you find yourself questioning certain insurance claims and need an in-depth investigation to uncover insurance fraud, you can hire our expert private investigators and we will take care of the rest for you.



Reid Latham
Easy to talk with and does a great job! Very discreet and a pleasure to work with. They know what to do and how to do and when to do it.
Jesse McGeE
10 out of 10 great people and very professional. 5 stars all the way.
James Martin
From my experience of knowing the Hawkins family. If you want professional service and dependability try Upstate Private Investigators.