Insurance Fraud
Introduction
Insurance Fraud refers to an illegal act on either the buyer or seller of the insurance contract. The buyer insurance fraud may include exaggeration of claims; falsification on medical history faked death or kidnap or postdated policies. Insurance fraud by the seller may include, churning policies to obtain more policies, offering policies from non-existing companies and failure to submit premiums. Majority of insurance fraud cases involve attempts to exploit the insurance contract for financial gain through exaggeration or falsification of the claims. Insurance fraud costs North Carolinians between 15 to 20 cents on every dollar paid on premiums (Robesonian, 2020). A case reported on the Robesonia Newspaper on Feb. 20, 2020, is aa perfect example of a breach of an insurance contract for financial gain by the buyer (Robesonian, 2020). According to the insurance commissioner, Mike Causey, Samuel Lee Lang Johnson, aged 43 years from Freedom drive 2703 is accused of felony insurance fraud, misdemeanour making false statements on the insurance contract application and obtaining assets through falsification and exaggeration. Johnson is accused of submission of false and multiple claims between to Allstate Insurance firm for 2004 Buick Rendezvous SUV damages. Johnson obtained payments from the insurer after submitting false information during the application process. Johnson was arrested on Jan. 23 following the raising of the alarm by Allstate Insurance Company. The paper identifies the Types of evidence you would look for in this type of case, the procedure of evidence gathering, the methods of cataloguing and maintaining evidence and how to present the evidence. For an effective trial of Johnson Insurance case, Allstate Insurance firm must gather and submit convincing evidence to the court of law as a proof that the accused breached the insurance contract through exaggeration, and misdemeanour making false statements and present it clearly and understandably. Evidence is the building blocks for every investigative process and for the final product to build evidence properly ought to e recognized, collected and documented properly, protected, analyzed, disclosed and presented acceptably in a court of law.
Types of Evidence
The Accuser is required to produce a piece of documentation evidence to prove that Mr Jonson had a submitted a false, multiple application. To cement their case, primary evidence which is considered as the top class evidence will be necessary. Primary evidence involves the original documents that need to be submitted to the court for inspection. Allstate Insurance firm is required to submit evidence that shows that the accused had breached the insurance contract by making multiple application. The Accuser is required to produce the documentation evidence on the number of applications Mr Johnson Attempted. Allstate Insurance firm should further produce documentation evidence that proves that Mr Johnson applied and received compensation on the property under investigation. Additionally, Allstate Insurance firm should produce a piece of demonstrative evidence. Demonstrative evidence is submitted to the judge as charts, diagrams or illustrations of the testimony. The insurance company ought to demonstrate to the judge how Mr Johnson made the multiple applications and how the law of the contract was breached in that case. Such evidence is essential in opposing the counsel while proving a contrary position.
The Accuser may further be required to produce circumstantial evidence to prove an issue by providing other facts. Circumstantial evidence is achieved y providing other facts that are indirectly and proving their relevance or relating series of other facts in the issue. The associated facts have a cause and effect relationship, which helps the Accuser to prove their point. The Accuser is also required to produce direct evidence that is considered as compelling evidence in deciding the matter in the issue. In such evidence, a specific fact may be established directly without necessary establishing a connection to the fact. Such evidence is usually real, tangible that require no thinking or further considerations in proving it. For the cases study providing for 2004, Buick Rendezvous SUV and evidence and documentation evidence on multiple application as well as compensation claim application will serve as direct evidence that does not require further illustration or further proving. In circumstances where statistical or physical data is not available, the Accuser may be required to offer analogical evidence. Analogical evidence comes into play at the end moment and helps to create a link between the accused and their actions. The Accuser will be required to provide evidence that links Mr Johnson to the illegal insurance contract breach actions. Inculpatory evidence is required to link to directly or indirectly link the accused person to the offence under investigation (Nguyen, 2020). Inculpatory evidence can be obtained from the victim’s complaint, physical evidence, or circumstantial relationship. Natural evidence showing that the accused committed the crime is the most preferred inculpatory evidence, but that may not be practically available. The investigator will, therefore, be required to interpret other evidence and information to be achievable at a reasonable ground to believe and allow the judge to believe beyond any reasonable doubt.
Methods/Procedures for Gathering the Evidence
Before beginning the fraud investigation, it is first very crucial to conduct an initial assessment. Initial access easement involve understanding who, what, when and how the case occurred. The process begins with obtaining as much as possible evidence before the client could dispose of or delete some of it. The Accuser should do a background check to understand who Mr Johnson is and any pending fraud or legal suits he may be having before embarking on presenting the case before a court of law. They measure to allow the Accuser to argue from an informed grounds. It is recommended to generate an investigation plan that outlines who to interview and how to do it. The investigation plan outlines the kind of data out to be gathered and how to gather it. It documents everything that must be done and how from the start to the end.
Photography of relevant evidence is an essential data gathering in most lawsuits. Conditions of the evidence can change with time, and it is hence very crucial to have photographs in the claim in the litigation process. For the given case study, photography to determine the damages in the 2004 Buick Rendezvous SUV will help in developing reliable water-tight evidence. The conditions of the asset can be easily altered to poke holes on the evidence by the defendant team. The evidence is further collected by obtaining softcopy and hardcopy files on the accused transactions with the insurance firm. All the documentation evidence is obtained from previous applications from the system and stored in both soft and hard copy. The required data is when the application was made, the documents used when the request for compensation was made, and the documents provided to facilitate the process. The investigator should further interview with the technical team involved in the insurance process to develop an understanding of the technical aspects of the case. The parties that by any reason, know the ongoing lawsuit ought to preserve the evidence from malicious damage or alteration. For instance, many companies are required to maintain the surveillance footages or emails for a certain time in case a legal suit comes up (Pavletic, 2018). While gathering evidence for a potential legal suit, it is further essential to preserve documents and materials that are relevant to the litigation. Failure to preserve the evidence may lead to losing the lawsuit by default and serious instances of deleting the evidence.
Methods to Catalog and Maintain the Evidence
All the evidence collected in the investigation is inventoried and packaged to prevent any loss, damage or alteration. Where possible, the items are marked and given a serial number. For items that cannot be marked, they are appropriately preserved in an envelope or container. The important marking on the evidence includes agency case number, item number, investigator initials and the date recovered or received (Bergma & Berman, 2020). The evidence must be arranged systematically for easy retrieval and avoid spoilage, alteration or damage. The process of requesting, sorting through paper documents, electronic media and any other form of evidence from the parties is very tedious and time-consuming. Cataloguing can be done by creating indexes and databases for the most vital documents for eases retrieval. The collected documentation evidence such as photos, insurance application details should be electronically catalogued and given indexes for ease and faster retrieval.
The investigator must put measures to maintain the obtained evidence and protect it from spoilage. Evidence spoilage refers to intentional, alteration, destroying or negligently withholding evidence that is relevant to legal proceedings. In the post-Enron age of technology, the investigator ought to prevent shredding documents pending lawsuit. The created database to store soft copy evidence ought to be secured through end to end encryption, passwords and any other form of digital data protection. The evidence documents should be backed up, printed out or saved in CD-ROM or flash disk to prevent any loss in case any of them is deleted. Litigation holding should apply for any data in which litigation is anticipated. The company should keep emails or information on any form of transaction that might have occurred with the accused.
Presenting the Evidence
The evidence to be presented include application documents both soft copy and hard copy, prove of multi-application, an exhibition of the insured asset and photos. The first step in presenting evidence involves identifying what the court wants and what you need to show. The information presented in the court is dependent on what one wants from the court and the law of that state (Bergman,& Berman, 2020). The second stage involves identifying the potential evidence whichis inform of exhibitions such as photographs, voicemail and video recording, objects and communication such as email as well as testimonials. From the identified evidence, the plaintiff should select the evidence that proves what he needs to show to the court. The evidence selected should be that one that a judge can rely on. The plaintiff has to explain the importance and reliability of exhibits before being allowed to present them in the courtroom. The presentation should be organized to help you feel more confident in the courtroom.
References
Robesonian. (2020). Local man charged with insurance fraud | Robesonian. Robesonian. Retrieved Jul. 14 2020, from https://www.robesonian.com/news/132033/local-man-charged-with-insurance-fraud.
Nguyen, J. (2018). The Medical Malpractice Lawsuit and the Trial Process. Legal and Ethical Issues for Health Professions E-Book, 57.
Bergman, P., & Berman, S. J. (2016). Represent yourself in court: How to prepare & try a winning case. No.
Pavletic, J. (2018). The Fourth Amendment in the age of persistent aerial surveillance. The Journal of Criminal Law and Criminology (1973-), 108(1), 171-196.
