What are common red flags for insurance fraud that adjusters should watch for?

Insurance fraud costs the industry tens of billions annually and increases premiums for all policyholders. Adjusters are the first line of detection. Common red flags: (1) Implausible or inconsistent loss description — story changes, details don't match physical evidence, timing doesn't fit; (2) Suspicious policy timing — new policy or increased coverage shortly before loss (especially for total loss claims); (3) Financial pressure — recent bankruptcy, foreclosure, job loss; the insured may need cash; (4) Prior claims history — multiple similar claims, suspicious patterns across different insurers; (5) Lack of supporting documentation — no receipts for valuable items, no photographs of property, no police report for theft; (6) Claimant behavior — overly aggressive about quick settlement, unwilling to provide documentation, refusing examination under oath, threatening or intimidating; (7) Physical evidence inconsistencies — burn patterns don't match accidental ignition, theft scene doesn't show forced entry, damage inconsistent with described cause; (8) Witness issues — only family members witnessed, witnesses contradict each other, witnesses not available; (9) Suspicious provider relationships — same medical clinic, body shop, or attorney appearing in multiple claims. Red flags alone don't prove fraud — they trigger further investigation. The adjuster should: document the red flags; conduct additional investigation; consult SIU (Special Investigations Unit); be diplomatic with the insured; not accuse without evidence. Fraud convictions can result in prison time, restitution, and loss of insurance forever.