Fraud Risk Scheme:
A policyholder intentionally conceals critical medical history when applying for a life insurance policy to obtain favorable terms or acceptance.
Detection:
Cross-referencing data: Verifying client statements against medical databases (with their consent) and insurance history records.
Automated alerts: System that flags abnormally high insured amounts relative to age and income.
Behavioral analysis: Detecting inconsistencies in responses during the health questionnaire.
Prevention:
Mandatory medical questionnaire: Requiring a medical examination for high coverage amounts.
Clear penalties: Explicitly informing about the consequences in case of misrepresentation.
Documentary verification: Requiring supporting medical documents for declared pre-existing conditions.
Advisor training: Teaching how to identify suspicious behavior during the application process.
Share your feedback:
What tools, techniques, and processes are used for detection and prevention?
