When presented with an incident loss description that does not appear to correlate with the vehicle’s actual physical damage, a claims adjuster must consider whether the damage could have been “enhanced” or otherwise fraudulently orchestrated.
To facilitate accurate claims processing, he or she may consult a forensic engineer, who will then carefully
examine the facts of the case. During
the course of a given investigation, this
forensic expert will employ various
scientific methods to determine if the
injuries claimed are consistent with
the circumstances of the accident.
In the following scenario, the collective expertise of an insurance claims
organization and an accident-reconstruction expert culminated in the discovery of fraud
and prosecution of the deceitful claimant.
Another Hit-and-Run Case
The claim involved a 2003 Dodge Caravan, which was reportedly damaged in
a hit-and-run collision. The incident resulted not only in a vehicle damage claim
but also injury claims by the driver and
five passengers allegedly in the vehicle at
the time of the accident.
Following the incident, police were
summoned. A complaint was completed on scene describing that the Dodge
Caravan—the claimant’s vehicle—was
struck from behind by an unknown vehicle that coincidentally left the scene
after, causing damage to the passenger-side rear bumper. It was noted that a formal police accident report was not filed
because of the minimal amount of damage observed by the responding officer.
In fact, the police complaint indicates,
“a dark-colored vehicle made contact with
[the claimant vehicle’s] passenger-side
rear bumper and left the scene without
stopping. Complainant had minor damage.” According to sworn testimony from
the claimant, the striking vehicle was described as a sport utility vehicle (SUV).
Prior to the insurer consulting ARCCA,
a forensic engineering and case consulting firm, the minivan had already been
repaired. However, photographs of the
vehicle damage taken during repairs were
provided. ARCCA was then retained to
review the matter and determine if the
damage to the vehicle was consistent with
the description of the loss.
There were several
inconsistencies both in
the perceived damage
to the vehicle and in the
resulting from the alleged
The testimony of the claimant driver
and that of the five occupants unanimously indicated a single impact. But
were they telling the truth?
There were several inconsistencies
both in the perceived damage to the vehicle and in the occupants’ kinematics resulting from the alleged collision. For instance, it was stated that the rear window
(which is tempered glass) was cracked,