AICPA Insurance Programs

Avoiding Fake Slips, Trips, and Falls

 

Tips Your Clients Need to Avoid Fraudulent Slip and Fall Claims

 

Slip and fall claims represent a significant fraud risk because they can be easy to fake and difficult to disprove. And any location where the public is invited — grocery stores, restaurants, banks, etc. — is vulnerable.

 

Opportunities Abound

“The people who would attempt insurance fraud see a wet floor or a grape on the floor as an opportunity,” said Jack McGoldrick, Director, Hartford Special Investigations. “There are people who make an absolute living at it.”

 

In some instances, the fraud artist will even create an opportunity. In a recent case in a Texas sandwich shop, one employee claimed to have slipped in a puddle of water and injured her shoulder. She promptly left work and sought medical treatment.

 

Caught in the Act

In a routine review, the Hartford claims handler discovered another slip and fall claim in the claimant’s history and referred the case to the Special Investigations Unit. The investigator visited the sandwich shop and was able to access security camera footage. The surveillance video revealed that the claimant had sprayed water on the floor before lying down in it and calling out for help. It was an open and shut case at that point.

 

The employee was fired. The claim was denied. The case was referred to the Texas Department of Insurance Fraud and the National Insurance Crime Bureau, which presented evidence to the district attorney’s office for possible prosecution.

 

Watching for Fraud

The preceding example shows that while fraud can be overlooked, Hartford claims professionals are well trained to spot indicators of possible fraud and to investigate those cases. Further, it demonstrates that while fraud can be difficult to prove, with the right precautions, business owners can protect themselves.

 

Video cameras, according to Hartford Special Investigations Manager Odie Waters, are one of the most effective measures a business can undertake. “Surveillance systems are not that expensive to purchase and maintain,” he said. “And they can save you a lot of trouble.”

 

In addition to reviewing video footage, the Hartford investigator may take other steps to investigate potential fraud, such as visiting the scene, interviewing the claimant and witnesses, and verifying that the claimant’s treatment actually takes place.

 

Tripping Up Fraud Artists

A business can also take steps, both before and after an incident, to reduce its exposure to fraud:

·     Eliminate the opportunity for fraud. Maintain facilities inside and out. Keep floors clean, dry, and clear of debris. Thoroughly clear sidewalks of snow, ice and other hazards. Repair damaged sidewalks, parking lots, and other walkways that customers use to enter and exit the facility.

·     Document prevention efforts. Check public areas frequently, on a regular schedule, and keep a detailed log of cleaning and maintenance activity: list each task, who performed it, when, and where.

·     Install a video surveillance system. View and capture video immediately after an incident. Many systems reuse tape — they often run on a 24-hour loop — so the footage will be erased if not properly secured after an incident.

·     Take photos of the area, and of whatever hazard the person claimed to slip or trip on. Be discrete and considerate, but photos of the accident scene can be invaluable in managing the claim and any fraud investigation.

·     Identify witnesses. Act quickly to secure names and contact information. Often, in cases of fraud, a witness might say, “Yes, I saw the fall and he just laid down on the ground and then called out it pain. It looked really fake to me.”

·     Be thorough in collecting details. In an authentic slip and fall, the person will usually land in the substance they slipped on. Is there any sign of the substance on the person’s clothing? Is there evidence of a slip mark on the floor? Is a witness overly enthusiastic? This can be a sign of two people working together. Any unusual aspects of the incident should be noted.

 

If anything about an incident makes you suspicious, alert the claims handler or contact The Hartford’s Fraud Hotline at 1-800-547-WARN.