Much of the value of SIU’s cannot be readily quantified. The fraudulent claims that are either never submitted or are submitted to other insurers instead of your company are the ones that you don’t see.
Insurers build their reputations regarding their resistance to fraud over time. Fraudsters communicate with each other. They know who the “easy touches” are. The most effective companies are those that establish a sensible policy, implement it and stick with it. Those that vacillate with every swing of the market defeat themselves.
Claims supervisors are critical to effective referrals to SIU’s. Many claims adjusters learn quickly not to see fraud, because a referral to SIU will only slow down their closure and increase their pending. It is much easier for an adjuster to write a check and be done with the claim. Claims supervisors are seasoned professionals who know the subtle signs of a bogus claim, and are in a position to hold the adjusters’ feet to the fire.
Readers may wish to visit my website, http://www.seattle-investigations.com, and check the link at the bottom of the page for my “public folder.” There is a powerpoint presentation there entitled “Insurance Fraud Investigation” which adjusters, SIU and management should find informative and relevant.
We have updated our privacy policy to be more clear and meet the new requirements of the GDPR. By continuing to use our site, you accept our revised Privacy Policy.
Much of the value of SIU’s cannot be readily quantified. The fraudulent claims that are either never submitted or are submitted to other insurers instead of your company are the ones that you don’t see.
Insurers build their reputations regarding their resistance to fraud over time. Fraudsters communicate with each other. They know who the “easy touches” are. The most effective companies are those that establish a sensible policy, implement it and stick with it. Those that vacillate with every swing of the market defeat themselves.
Claims supervisors are critical to effective referrals to SIU’s. Many claims adjusters learn quickly not to see fraud, because a referral to SIU will only slow down their closure and increase their pending. It is much easier for an adjuster to write a check and be done with the claim. Claims supervisors are seasoned professionals who know the subtle signs of a bogus claim, and are in a position to hold the adjusters’ feet to the fire.
Readers may wish to visit my website, http://www.seattle-investigations.com, and check the link at the bottom of the page for my “public folder.” There is a powerpoint presentation there entitled “Insurance Fraud Investigation” which adjusters, SIU and management should find informative and relevant.