Koyal Group Training Services, How to prevent fraudulent claims?

How to prevent, detect and investigate fraudulent claims

Insurance fraud equates to around £16m every week and £840m a year. The footage below shows a college student noticing water in the reception area and then intentionally slipping over, which resulted in a fraudulent insurance claim.

Injury claims in the workplace are a prime example of where a fraudulent claim may be made. These arise from an allegation that the organization was negligent, allowed the situation to become dangerous and led to a foreseeable risk.

A few practical, preventative steps will reduce risk and cut the time, effort and cost of investigations. By implementing a policy of regular inspection, risks will be identified sooner and accidents could be prevented. 

Ensuring that all inspections are carefully documented means they can be presented as evidence in court if it becomes necessary to defend against charges of negligence. At the very least, you should make every effort to disrupt the activities of the would-be fraudster who thinks that you are a soft touch. Installation of CCTV cameras is an important preventative measure.

Remember, if you do have a claim against you, act quickly. If you delay, valuable evidence will be lost and lawyers will apply pressure. So much more can be achieved if you keep one step ahead of the fraudster. By putting your strategies in place as soon as possible, you can be ready to deal with the claims quicker, more effectively and more efficiently.

Consider taking these steps to help detect fraud:

• Don't delay – this may lead to pre-action discovery proceedings and other increased costs.

• Visit the scene as soon as possible to obtain your own photographic evidence.

• Validate every piece of information that is presented to you.

• Refer suspicious claims to a fraud coordinator for an expert opinion.

• Check the claimant exists on the electoral role and investigate their living situation.

• Liaise with regional counterparts to deliver a consistent approach in your prevention and sanctions.

• Consider visual mapping of claims to see if a pattern emerges regarding the location of incidents and claimants, (e.g. clusters of claims in a particular area).

• Check for similar handwriting on sketches to track regular claimants or intermediaries.

• Deploy effective staff training in claim investigation techniques.

How Zurich Municipal combats fraud in insurance

At Zurich Municipal, we strongly believe in embedding fraud detection within all areas of claims handling, providing staff with the knowledge and tools to ensure that all suspicious activity is properly and thoroughly investigated. 

• Zurich has a dedicated Claims Investigation Unit (CIU), a team of 30 professionals who focus on the investigation of suspicious claims, raising awareness amongst staff and customers, and gathering and sharing intelligence.

• In addition, there are more than 25 full- and part-time fraud handlers and coordinators at our claim-handling sites to ensure that all suspicious claims are referred for investigation.

• We have a panel of approved suppliers and solicitors who complement the work we do in-house.

• Training is regularly delivered to all claims staff to make sure they know what fraud looks like and where they should refer the claim to.

• We will always look to prosecute fraudsters when the evidence exists, working closely with the Insurance Fraud Enforcement Department

• We contribute to industry initiatives, such as the Insurance Fraud Bureau, to ensure that Zurich is strongly represented.