{"id":1632,"date":"2020-10-30T13:54:54","date_gmt":"2020-10-30T13:54:54","guid":{"rendered":"https:\/\/crigroup.com\/?post_type=blog&p=1632"},"modified":"2021-10-08T11:34:48","modified_gmt":"2021-10-08T11:34:48","slug":"the-unseen-enemy-insurance-fraud-part-ii","status":"publish","type":"post","link":"https:\/\/crigroup.com\/ar\/the-unseen-enemy-insurance-fraud-part-ii\/","title":{"rendered":"The Unseen Enemy: Insurance Fraud – Part II"},"content":{"rendered":"

This three-part series of articles examines the problem of insurance fraud, including its pervasiveness and general characteristics in the United States, the United Kingdom and the world. Insurance fraud is a widespread problem that requires real solutions and is often difficult to detect and combat.<\/p>\n

Part One of the series, \u201cWhat is Insurance Fraud,\u201d<\/a> provides an introduction to a topic that is important for any business leader, insurance professional, compliance agent or fraud investigator. Part Two, \u201cHow do Companies Detect Insurance Fraud,\u201d details red flags of insurance fraud that help tip off investigators to possible illegal behaviour. Part Three, \u201cAnatomy of an Insurance Fraud Investigation,\u201d provides a look at case studies and reveals key tips for handling a successful investigation. To receive the next series subscribe to our monthly newsletter here<\/a>!<\/p>\n

Taken as a whole, this series is the perfect primer for any insurance fraud professional and companies looking to avoid becoming victims of insurance fraud claims. It provides the tools and knowledge needed to effectively combat insurance fraud.<\/p>\n

Part Two: How Do Companies Detect Insurance Fraud?<\/em><\/h3>\n

The insurance fraud epidemic is of serious concern to businesses, insurance providers and consumers worldwide. In Part One<\/strong><\/a> of this three-part series, we examined the scope of the problem, and discussed a few cases that illustrate the magnitude of insurance fraud. In Part Two, we answer the question: How can companies detect insurance fraud cases before they do irreversible damage? Working with the right experts, any company can be better protected and detect more insurance fraud.<\/p>\n

CRI Group\u2019s expert insurance fraud investigator<\/a>s have the experience and training to help business leaders identify the red flags of insurance fraud, alerting them to<\/p>\n

The following are 6 red flags of Insurance Fraud that CRI Group\u2019s investigators<\/a> are trained to recognise:<\/p>\n

1. Suspicious timing<\/h3>\n

Sometimes a claim is made very shortly after the inception of the policy, such as within months, weeks or even days after the insured has been enrolled. This is an obvious red flag, yet it happens more often than you\u2019d think. Another similar tip-off to potential fraud is when the insured makes a claim soon after an increase or change in the coverage. For example, a motorist increases their auto coverage from liability to collision insurance, and soon after files a claim under their collision policy when their car is \u201ctotalled\u201d in a one-vehicle accident. An investigator from CRI Group would certainly look deeper into the circumstances of the claim.<\/p>\n

2. Frequent insurance claims and losses<\/strong><\/h3>\n

We often hear that \u201csome people are just unlucky.\u201d That may be true, but a string of alleged bad luck that results in frequent insurance claims and payouts can signal that there is more than meets the eye. CRI Group is trained to look at the history of every claimant and uncover potential fraudulent actions. Some insurance fraudsters think they can avoid detection by filing their claims in totally different areas, like auto, health and homeowners\u2019 insurance. Expert investigators know how to put those pieces together to look for trouble signs.<\/p>\n

3. Sketchy details<\/strong><\/h3>\n

Sometimes a claim for theft or fire will be for recently purchased and\/or expensive property, without a lot of documentary evidence to back up the claim. That\u2019s a red flag, along with when an insured cannot remember, or does not know, where the claimed property was acquired, or cannot provide adequate descriptions. A proper insurance fraud investigation will seek to corroborate the details of the claim, and require an examination of all supporting documentation to make sure it is complete and legitimate.<\/p>\n

4. Details that are \u201ctoo perfect\u201d<\/strong><\/h3>\n

On the other hand, sometimes the details surrounding a claim seem perfect \u2013 a little too perfect. CRI Group has investigated cases in which the insured had receipts and other documentation, witnesses, and duplicate photographs for everything. So what\u2019s the problem? Things lining up a little too perfectly can tip off an investigator that things have been planned and orchestrated, and there might be fraud involved. That\u2019s when it\u2019s time double-check the documentation carefully, and interview witnesses to verify the facts.<\/p>\n

5. Irregular documentation<\/strong><\/h3>\n

We\u2019ve discussed the importance of documentation in the investigation of a claim \u2013 whether it might be missing, or seems to be \u201ctoo perfect.\u201d But sometimes the documentation provided by the insured is irregular or questionable, which is another red flag of insurance fraud. CRI Group\u2019s investigators look for issues with documentation such as:<\/p>\n