Peers and Coworkers Offer a First Line of Defense Against Fraud

The first documented instance of insurance fraud occurred in 300 B.C. and continued to tiptoe through history, next landing on the historical timeline in Ancient Rome.  

Roman Poet Marcus Valerius Martialis (“Marital”) highlighted the evolution of the crime, referencing a suspected arson scheme where the homeowner recouped 5 times the value of his house. While house fires were common for the time, the potential for recouping far more than the original value was suspicious, and outside observers naturally questioned whether the fire was accidental or intentional. 

“…you paid two hundred for your house;

An accident too common in this city destroyed it.

You collected ten times more. Doesn’t it seem, I pray,

That you set fire to your own house…?”

Martial, Roman Poet

Risk versus reward motivates a fraudster

Motivation is a key aspect of insurance fraud schemes across the historical timeline.  A prudent fraudster must calculate the risk versus reward of attempting to commit their chosen fraud. The chance to recoup a greatly inflated value of, say, a house would certainly motivate those willing to take risks, especially if they found themselves under financial pressure. 

Financial crimes, while ever evolving and often challenging to detect, must first bypass the eyes of watchful observers. This becomes a significant consideration for the would-be fraudster.

  • Who will notice?  
  • How long can I keep this up?
  • Will someone turn me in?

Peers and coworkers can deter fraudsters

A fraudster’s family, peers, and coworkers are the first line of moral defense against insurance fraud. Untold crimes have been averted well before they ever happened, simply because someone would likely notice that the scam was occurring.

Unfortunately, a small subset of the population may remain willing to step over that moral line to attempt an insurance fraud scam. Where then do those watchful observers turn?

ICW Group offers an Anti-Fraud Hotline 855.ICW.FRAUD (855.429.3728). This serves as a place for witnesses and educated observers to report their concerns. 

To get the word out, take a look at the wealth of resources currently available to ICW Group policyholders, providing multiple avenues of sharing our Anti-Fraud Hotline with your Teams so that if they do see something, they know how to say something. 

Christopher Dill
Christopher Dill
Christopher Dill is the Special Investigations Unit Director at ICW Group Insurance Company. A Fraud Claims Law Specialist designee, he was a recipient of the National Health Care Anti-Fraud Association’s Investigation of the Year Award for his significant contribution to the successful resolution of “Operation Back Lash” – one of the largest workers’ compensation health care bribery schemes ever uncovered in San Diego County. Christopher has participated in over 30 criminal cases surrounding medical and legal providers attempting to defraud the Workers’ Compensation system. Christopher’s approach to insurance fraud investigations is a holistic one. From preventative education campaigns, to data analytics, to time tested investigative, and intelligence gathering techniques, it is Christopher’s belief that a multi-faceted approach to insurance fraud is necessary to a successful defense.

Related Articles

Commit Workers’ Compensation Insurance Fraud, and It Will Cost You

In early 2022 we told you about an upholsterer who was caught working another job under a different identity while earning disability benefits. ICW Group's Special Investigation Unit (SIU) launched...

Insurance Fraud Charge Leads to Restitution

In a 2021 Fraud Friday feature, we told you about a California man charged with eight felony counts of insurance fraud and attempted perjury after filing a workers' compensation claim for...

Top Three Reasons Employees Commit Workers’ Compensation Fraud

Creating the right work environment can help employers prevent workers’ compensation fraud. Over the years, workers have fallen prey to unlawful solicitors for unscrupulous providers who make false promises...

Sign up for the Work Comp Connect newsletter

Subscribe today and get work comp insights from ICW Group in your inbox.

Sign up for the newsletter