said by jrs8084:This wasn't an amateur job. You know your competitors. Do you have a gut feel about one of them?
I was brought in as a paid consultant by the insurance investigator. To maintain my "disinterested 3rd party" standing, I get paid for my time but cannot bid or do the repair work. I do this occasionally for insurance companies - it's usually for fires where I work with an outside engineer who also has "3rd party" status.
The police weren't even slightly interested in this case. The insurance company hired an insurance investigator who also hired a private investigator.
Long story short, it was a contractor who was working for the campus owner and they were in cahoots. Not enough evidence to prove it, so they paid the claim.
Here's pretty much how it has been explained to me by insurance investigators:
What the insurance company is required to do (and this depends on the state), is to notify law enforcement (police or district attorney) or an insurance board of their suspicion. If the reviewing body says they want to prosecute or there is enough evidence to deny, they hold the claim. They usually only do this on "slam dunk" cases.
Even though $100,000.00 seems like a lot of money, it could easily double or triple if litigation is involved. It's cheaper to pay it and move on (drop the customer). That's one of the reasons insurance is so expensive.
The insurance guys tell me that about 10% of premiums go straight to fraud.
·
