Insurance fraud indicators

Question 1

Questions claim’s reps can use to detect fraud

Answer 1

• Given the circumstances of the loss, what are reasonable or expected actions/responses of the affected party?
• Is part of the reasonable action or response missing?
• Has something been added to the reasonable action or response?
• Is there physical evidence to support the reported version of the loss?
• Is the loss as reported physically possible?
• Are records available from a third party, such as a governmental agency or retailer, that can confirm or refute the insured’s version of the loss?
• Is there a witness to the loss, and, if so, is the witness reliable?
• Is the fraud indicator based on conjecture or assumption?
• Is there a rational explanation for the fraud indicator?

Question 2

2 protections commonly found in the laws to help fraud investigation/ resolution

Answer 2

1. Extending the time limit a claim must be completed.

2. The insurer does not have to disclose to an insured that fraud is suspected if there is evidence.