As the NFL playoffs get under way, the drills and the hitting only reinforce the resiliency of the human body. Hits to the head, back, neck and side are often exponentially harder than many auto accidents; yet each year millions of dollars are paid out to compensate people for even the slightest fender bender.
Having investigated auto accidents for a number of years it often amazed me to see people walk away from totaled vehicles, rollovers and head on collisions with a few bumps and bruises while others claim injuries when there is no visible damage to their car.
Is it fraud? Is it possible to be injured in an accident with no visible property damage? The answer to both could be either yes, no or depends. Most certainly insurance fraud is an issue that plagues our society, costing the average family between $400 and $700 dollars per year according to the FBI.
Fraud comes in all shapes and sizes, from a staged accident to a person claiming to be hurt when they really weren’t. According to the Insurance Research Council, more than one third of all accidents involve claims for opportunistic fraud. Many of these claims involve low impact accidents.
So what is an insurer to do when a person files a claim for injuries, yet there is little to no property damage? Exactly what should be done with any claim; Investigate, investigate, investigate.
The very fundamentals of a proper claims investigation are driven by simple blocking and tackling maneuvers that will drive quality and results. A cornerstone of the investigation must include photos and measurements of both vehicles, as it is possible to have significant damage to one car and virtually none to the other, as may be the case with a Ford Focus rear ending a full size pickup in which case the former would under ride the latter, resulting in extensive front end damage and virtually no rear end damage.
Measurements are critical as well, as these can not only validate that the two cars indeed strike one another but can provide a bio mechanical engineer with critical data when determining velocity and resultant G-Forces exerted on the occupants claiming injury.
Statements should be taken from all parties, including any witnesses. Particular detail should be paid to not only the accident but any conversation or comments that may have followed, which can be indicators of opportunism. Consider the situation where the person claiming injury grabbed their neck and said, “I better call my lawyer.”
A thorough investigation will also include a detailed investigation into medical history. Did the party claiming to be hurt have a history of claims? Have they been in multiple accidents? Is there a pattern of claiming injury only when they aren’t at fault? Were there pre-existing conditions or intervening circumstances? What was their pattern of treatment? What was said to their medical provider?
By obtaining ten to twenty years of medical history, either through a voluntary medical release or discovery, critical clues can be unearthed to either validate or refute what a party is claiming.
Video surveillance, hospital checks in metropolitan areas of all known prior residences and canvassing of neighbors, co-workers and especially ex-spouses also provides valuable insight into claims that may be presented.
Lastly, a biomechanical engineer can review your case or even the vehicles, and provide an estimation as to the speed at the time of impact and even the likelihood of injuries based upon statistically valid sampling of accident victims from similar situations. However, you should keep in mind that they will not be able to say with 100% certainty that a person was or was not injured, just what the probability was which makes it that much more critical to meet the injured party and their attorney to assess credibility and witness potential.
Companies have adapted a wide variety of approaches to investigating low impact claims, ranging from aggressively fighting them to utilizing software applications to assist in gauging velocity and force on the occupants. The reality is that there is no one size fits all, as every case must be evaluated upon its merits with all evidence being considered. While there is generally a correlation between force and injury, there are exceptions to the rule, albeit rare on rare occasions.
When implementing processes to maximize your internal efficiencies and accuracy of settlement, consider your approach to low impact claims handling with particular attention paid to steps that should be taken during the investigation. Handling these types of claims take training, just like any other claim, and when properly investigated can have a significant impact on the bottom line.
Christopher Tidball is a contributing writer to several insurance trade magazines and the author of Kicked to the Curb. As a freelance writer and business consultant he shares is twenty plus years of insurance claims and quality assurance experience with industry leaders to assist them in developing innovative processes to improve productivity and bottom line profits. To learn more, please visit www.christidball.com or e-mail firstname.lastname@example.org.
Chris Tidball is a claims and revenue management consultant and author of the "20 Essential Rules" series of self and organizational improvement books. You can ask him a question at email@example.com