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Proving Insurance Fraud using Social Media

proving insurance fraud social media

Insurance companies are turning to new techniques and methods for proving insurance fraud using social media. Fraud steals $80 billion a year across all lines of insurance, according to the Coalition Against Insurance Fraud. The number of fraud cases has been rising over the last few years, primarily because of the increase of “soft” insurance fraud, which involves exaggerating a legitimate claim versus fabricating a new one.

Investigations may involve interviewing the people involved and witnesses, checking historical claims and disputes, looking at previous convictions, poring over financial records, examining physical evidence, doing a statistical data analysis – whatever it takes to disprove a false claim and save money. Social media discovery should be added to that list.

If an insurance claims adjuster does an investigation or if the insurance company’s attorney heads into a deposition without having done a social media investigation, he will only have half the story. Social media investigations can provide a wealth of information – especially considering that 77 percent of Americans have at least one social media profile, per Statista.

When people tweet, snap and post to Facebook, Twitter, YouTube, Snapchat or any other social media channel, much of that information is discoverable.

Even if the person being investigated doesn’t have much information on her social profile, her friends and family may have posts that give you the information you’re looking for. When that data is in the hands of a skilled team of forensic specialists and private investigators, it can be used to prove or disprove a legal matter.

Real-life examples of how proving insurance fraud using social media is successful include:

Personal Injury Claim

A young woman who worked as a lifeguard hurt her leg on a pipe at the pool and claimed an Achilles tendon injury, which she said caused so much pain and suffering that she was “unable to enjoy life” and “unable to move around,” and she was seeking a lot of money for compensation. Social media told another story. Her social media posts were investigated, some of which led to her personal blog and other platforms, and multiple pictures were discovered of her on exotic vacations hiking up waterfalls barefoot! Metadata obtained from the photos, which had been taken on a cell phone, gave the embedded date and GPS information, along with other data, allowing the team to prove it was a fraudulent claim.

Workers’ Compensation Claim

A man claimed his job was so stressful, he had posttraumatic stress disorder (PTSD) because of it. He said his PTSD was so intense, he couldn’t leave his house for anything, including going to work. However, the social media investigative team discovered that he belonged to a sub-group on Facebook that was specifically for Uber drivers in his area. He was frequently giving advice and posting about the best ways to travel, local traffic and road construction, the optimum times and areas to work and more. That not only proved that he could indeed leave his house, it also showed he had side revenue, which he hadn’t reported.

Medical Malpractice Case

Parents claimed their child, at the time in the third grade, had been permanently injured during birth, which kept him from being mobile or athletic. The claims adjuster was suspicious and requested social media discovery, which found that the child was a normal, active kid. In fact, evidence was uncovered that he took part in baseball and football camps and that he could run the 30-yard dash as fast as an eighth-grader.

Results like these can save insurance companies significant time and money. That’s why it’s critical to include social media in insurance investigations to prove insurance fraud.

Here are four tips for successful social media investigations:

1. Request social media discovery as soon as possible.

If the person being investigated gets wind that you are looking into his or her social media, they may delete posts or do something that limits access. If you wait a few months, the entire profile may even be completely shut down and off the internet. Information may still be found through connections on social media platforms, but the process can become more difficult and may not yield optimal results. It’s best to start the social media investigative process before the subject can do anything about what has already been posted.

2. Work with an experienced, well-rounded team.

Your ideal team should include certified forensic professionals, licensed private investigators, technical specialists and licensed attorneys – each of whom should be well-versed in digging deep to unearth the proverbial smoking gun. That combination ensures the research and analysis will be worked from multiple angles and that the entire process will be handled in a way that is ethical, defensible and compliant. They will also be able to advise on case strategy and provide expert testimony if it proceeds to litigation.

3. Use multiple tools and technologies.

A diverse team also brings a wide range of tools to employ, which gives you peace of mind that every scrap of pertinent information has been found. Investigative tools allow the team to locate subjects and their relatives and friends. Forensic tools and eDiscovery technology can crawl, capture and instantly search available content. Additional platforms can be used for reviewing the files in searchable native formats and producing data as requested by counsel or the court.

4. Ensure the process is validated and secure.

The social media investigation process should begin with a secure way to get the suspect’s information and keep any sensitive material, such as protected health information, encrypted and secure. As data is collected and indexed from social media streams and linked content, it should be automatically logged with hash values created, which authenticates the files and shows they have not been tampered with. All metadata should be preserved, including fields that are unique to each social media platform, and reports on the data should be automatically generated. Additionally, detailed documentation should be provided on all work and analysis, as well as the results achieved.

Most Americans use at least three different social media platforms, per a 2018 study from Pew Research, and the number of people using social media has continued to grow over time. Because these platforms have become a common and accepted way to converse and share with others, people are used to posting things and then not giving it another thought.

That can make social media a gold mine for investigations into potential fraud and should become standard practice for insurance companies.

Read more about BIA Social Media Investigations and its use beyond fighting insurance fraud but also for use as a discovery tool in litigation and for employee background checks.