A STEP AHEAD. The industry must work together in the fight against insurance fraud

Speed is of the essence in order that honest policyholders have a positive customer experience and are reinstated swiftly. However, whilst it is important that claims are validated quickly, it is also essential that the validation process is undertaken properly, to ensure that the premium pool, which is funded by all policyholders, is not depleted by fraudulent activities. Effective investigation and the delivery of an excellent customer service need not be mutually exclusive.

Nowadays insurers can use technology and counter-fraud intelligence services to speed up investigations, delivering operational efficiencies and reducing the time taken to collect and integrate key information. Investigation management systems can assist insurers with mitigating risk and optimizing their counter fraud resources most effectively. Desk top tools can complement existing anti-fraud strategies and now provide insurers with a single point of access, real time, to extensive consumer intelligence. Systems and workflow processes can be streamlined to create an immediate profile of a customer, together with their claims history and provide insurers with a consolidated view of the risk and potential areas requiring further investigation.

The debate on whether to outsource claims investigations, handle internally, or take a combined approach, remains lively. Many insurers feel that managing and controlling the investigation process in-house is the only way to ensure that policyholders are not disrupted and disaffected by an investigation into their claim circumstances. Conversely, other insurers believe that by outsourcing the investigation process they disassociate their brand from any potential negative reputation issues. Certainly the market as a whole recognises the potential reputational risk linked to claims fraud investigation.

An example of such sensitivities and an area that perhaps requires better industry definition, is the use of social media in claims investigation. Whilst insurers acknowledge the benefits of this information source, there is concern around what is acceptable both in terms of legal evidence which would be upheld in court and risk to reputation if an insurer is seen to have infringed a policyholder's right to privacy. Whilst social media based investigations can be seen to be on the increase and results used to complement existing counter fraud strategies, the insurance industry as a whole has yet to embrace and embed this tool.

The insurance market recognises that increased co-operation, joined up thinking and a collaborative approach to the management of fraud is vital to staying one step ahead of the fraudsters. Information sharing between insurers and the funding of industry bodies such as the IFB and IFED are good examples of the industry’s commitment to the power of a collective approach. Further co-operation which could benefit the united fight against fraud is a joined up approach to consumer education on insurance fraud. Insurers promote their position on fraud to varying degrees. A ‘zero tolerance to fraud’ championed by the entire industry and reinforced at individual insurer level would act as a strong deterrent to ‘would be’ opportunists and organised fraudsters. When the insurance buying public really understands that insurance fraud is not a victimless crime and that it hits their pockets too; then the industry will begin to influence public opinion and make insurance fraud socially unacceptable.

by Sara Costantini, Director at CRIF Decision Solutions Ltd

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