When processing your personal injury claim, you need to be aware of the following red flags which may cause suspicion in your case, leading to further investigation or denial of your claim. Some of these red flags include the following:
- Lack of credibility of your medical provider;
- Abnormal increase in treatment;
- Attorney/doctor established relationship; and
- Disproportionate medical expenses to vehicular damage.
Lack of Credibility of Your Medical Provider
There are certain signs that your medical provider may not be credible:
- The address on documentation for your physician is incorrect;
- The medical facility often changes names;
- The medical facility operates under multiple names;
- Billing is received for unnecessary services;
- Billing is received for unrendered service;
- You are unable to define the medical ailment as listed in the medical records; and
- You were referred to the medical facility or doctor by a friend, whom you cannot remember.
Abnormal Increase in Treatment
Insurance companies compare the standards of that particular carrier with the amount of medical treatment you have received. If your amount exceeds the norm, then they adjuster may be suspicious that your case is built up. This may get your case flagged for the Special Investigation Unit.
Attorney/Doctor Established Relationship
If the primary treating doctor frequently works with your attorney, this may cause suspicion that there may be fraud. Again, for this reason, your case might get flagged for the Special Investigation Unit.
Disproportionate Medical Expenses to Vehicular Damage
While your medical providers might believe that vehicular damage does not directly relate to the amount of treatment you need, insurance companies will suspect fraud if your medical bills far exceed the amount of damage to your vehicle.