Fraud Risk Scheme:
A policyholder attempts to have insurance cover damages that existed before the reported incident, presenting them as recent to obtain illegitimate compensation.
Detection:
- Analysis of photos and documents to identify the age of damages.
- Comparison with previous assessments or inspections.
- Verification of invoices or maintenance records predating the claim.
- Review of prior claims to detect similar or recurring incidents.
Prevention:
- Systematic on-site assessment for high-risk assets.
- Request for dated evidence (photos, invoices, technical reports).
- Centralized database of prior claims for cross-checking.
Share your feedback:
What tools, techniques, and processes are used in your organization to detect and prevent such fraud schemes?
