Fraud Risk Scheme:
A policyholder or a third party alters or exaggerates information about a real loss to obtain higher compensation or cover damages that are not insured. Fraud may involve the amount of damage, the circumstances, or the date of the incident.
Detection:
Comparison between the claim and the actual findings (on-site assessment, photos, technical reports).
Analysis of temporal inconsistencies (incident date, reporting delays, sequence of events).
Verification of supporting evidence (photos, invoices, witness statements, videos).
Cross-checking with previous claims to detect recurring patterns.
Prevention:
Mandatory detailed claim forms including all necessary information and supporting documentation.
Penalties for false declarations, including financial and legal sanctions.
Educating policyholders on the legal and financial consequences of fraudulent claims.
Random checks and systematic assessments for high-risk claims.
Share your feedback:
What tools, techniques, and processes are used in your organization to detect and prevent such fraud schemes?
