In the good old days before there were organized police forces, it was left to a few individuals to enforce the law. When they proved inadequate, there were feuds and vigilante action by the victims. Obviously, this fighting disturbed everyone, so states slowly got into the law enforcement business, recruiting and training people to keep the peace and identify criminals. Today, we rely on state and federal policing agencies, supported by CSI and other forensic agencies. But there’s been a fundamental and unchanging truth from the early days. More people avoid detection and profit from their crimes than are caught. That’s why the courts are forced to use deterrent sentencing. What judges are saying to potential criminals is there will be long periods of imprisonment if they are caught. The irony is that, if people were sure they would be caught, lighter punishments would be sufficient. It would cost us less to keep all these people in jail. Our society would be safer.
So why is it so difficult to detect fraud? Surely dishonesty should be obvious to an experienced insurance company? Well, sadly, detecting which claims are fraudulent is not easy. Let’s take a simple question. Both drivers involved admit there was an accident. One driver submits a medical report showing neck injuries. On what basis should the insurer challenge the medical report? Well, detailed investigation might show this particular clinic advertises for people to report accidents to them. Or this clinic may consistently be receiving business through referral networks. Either way, the clinic is found to specialize in the treatment of traffic accident injuries. This could make them highly skillful and deserving professional respect, or it could suggest the clinic exaggerates the injuries for its own profit when it bills for treatment, paying commission to referral agents and passing only some of the benefit on to “patients” who get settlements for their injuries. Is an insurer supposed to get a second opinion from an independent doctor on every patient from suspect clinics? Or suppose someone wants to get out of an auto loan so stages a small accident and pays a repair shop to set off the air bags and certify more serious damage so the vehicle will be totaled. If this is a one-off event and there’s no pattern to suggest this repair shop is dishonest, why should this particular claim set off alarm bells?
There’s no doubt the level of fraud has been at epidemic levels for a decade and more. Several billion dollars a year are being sucked out of insurance companies by criminals. In turn, all these losses are passed on to us in higher car insurance rates. This makes insurance fraud a political issue, albeit mainly in the no-fault states where the levels of dishonesty seem to be higher. Although there’s a National Insurance Crime Bureau established with the task of coordinating the fight against fraud, there’s little sign of success. It will take a major cultural change to deter people from this type of crime when the chances of being caught are so low. Even when staffing levels are improved by the insurers and the law enforcement agencies, there’s little observed change in behavior. The fraudulent claims keep coming in and the auto insurance quotes keep rising.
