How predictive modeling is flagging fraudulent claims

It can be a balancing act to identify potentially fraudulent claims and still provide superior customer service for justified claims, a handful of factors can ensure success.

By Donald Siegrist | Updated on January 11, 2016

A rather typical business story became a head-scratcher of a Workers’ Comp claim — and an illustration of the power of predictive modeling — when a seemingly “normal” claim was flagged for potential fraud.

A person traveling for business stayed in a hotel, as many people do when they travel, but with a twist. He filed a Workers’ Compensation claim for supposedly suffering an injury after falling off a chair in his room. According to the claimant, he could no longer work, but he didn’t expect that a predictive modeling tool would flag his case based on his occupation and other factors, bringing it to the attention of the insurer’s Special Investigations Unit (SIU).

Want to continue reading?
Become a Free
PropertyCasualty360 Digital Reader.

INCLUDED IN A DIGITAL MEMBERSHIP:

All PropertyCasualty360.com news coverage, best practices, and in-depth analysis.
Educational webcasts, resources from industry leaders, and informative newsletters.
Other award-winning websites including BenefitsPRO.com and ThinkAdvisor.com.

Already have an account? Sign In Now

NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.

Dig Deeper

Recommended Stories

Pet insurance gross written premiums grew more than 20% in 2023

Steve Hallo | April 11, 2024

The sector’s gross written premiums have been growing by 20%-30% annually since 2020.

Survey blames class action spike in-part on surge in 'employee activism'

Trudy Knockless | April 11, 2024

Labor and employment class actions accounted for 43.4% of legal departments' class action matters in 2023 – an increase of nearly 10 percentage points from a year earlier.

Employees embrace AI efficiencies, look past cybersecurity concerns

Joel Kranc | April 16, 2024

A new study underscores the idea that many workers continue to use unsecure personal devices for their jobs.

Resource Center

This guide empowers insurance carriers and risk managers to navigate complex regulations, safeguarding their brands from costly SMS and text messaging penalties.

Guide

Sponsored by gryphon.ai

The Ultimate Guide to SMS/Text Messaging Compliance

This guide empowers insurance carriers and risk managers to navigate complex regulations, safeguarding their brands from costly SMS and text messaging penalties.

Browse More Resources ›

Navigating the complexities of P&C core insurance digitization is no easy task. Explore the critical decisions between building or buying and how to achieve operational excellence in this white paper.

White Paper

Sponsored by Origami Risk

Build or Buy? Considering the Critical Decisions in P&C Core Insurance Cloud Digitization Projects

Navigating the complexities of P&C core insurance digitization is no easy task. Explore the critical decisions between building or buying and how to achieve operational excellence in this white paper.

Browse More Resources ›

As more customers “unbundle” their insurance products and spread their business among many carriers, agents must look for creative strategies to retain and grow business. Download this white paper to learn top strategies to ensure success in 2024.

White Paper

Sponsored by Melissa

Clean Your Data to Win the Customer Retention War

As more customers “unbundle” their insurance products and spread their business among many carriers, agents must look for creative strategies to retain and grow business. Download this white paper to learn top strategies to ensure success in 2024.

Browse More Resources ›

PropertyCasualty360

Don’t miss crucial news and insights you need to make informed decisions for your P&C insurance business. Join PropertyCasualty360.com now!

Unlimited access to PropertyCasualty360.com - your roadmap to thriving in a disrupted environment
Access to other award-winning ALM websites including BenefitsPRO.com, ThinkAdvisor.com and Law.com
Exclusive discounts on PropertyCasualty360, National Underwriter, Claims and ALM events

Already have an account? Sign In Now

Copyright © 2024 ALM Global, LLC. All Rights Reserved.