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. Examples of
this include:
• 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.
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