Insurance expert witness Barry Zalma and principal of Zalma Insurance Consultants writes that It is Necessary to Know Insurance to Fight Insurance Fraud.
Insurance fraud is a multi-billion dollar, complex, multi-faceted problem.Those charged with investigating and detecting insurance fraud must institute a serious and detailed training program for its fraud investigators to make them knowledgeable, at the very least, about:
* How to read and interpret an insurance policy
* How to enforce the material conditions in a policy of insurance.
* How to enforce the warranties in an insurance policy.
* The effect of a material misrepresentation or concealment of a material fact at the time a policy is acquired.
* The crime of insurance fraud and the evidence necessary to prove the crime.
* How “red flags” of insurance fraud lead to evidence but are not evidence of fraud. Insurance fraud is a multi-billion dollar, complex, multi-faceted problem.
If insurers refuse to train their people they will continue to detect fraud, investigate it thoroughly, and then pay the perpetrator because they failed to prove a viable defense to the fraud.