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Investigative & Forensics

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Claims covers many aspects of fraudulent claims - how they are perpetrated, red flags to look for in a claim, provides examples of fraudulent claims and the consequences for the perpetrators, and highlights the most egregious fraudsters in our annual Hall of Shame feature.

  • News  

    'People, analytics & partnerships' are key to fighting fraud, Travelers reports

    Steve Hallo |

    A panel of scam fighting experts also detailed the role agents and brokers play in stopping insurance fraud during a recent 'Wednesday with Woodward' event.

  • Research  

    Insurance fraud fighters are planning to accelerate adoption of AI tools

    Steve Hallo |

    While AI and ML tools garner interest, their adoption for fraud detection has only increased by around 5% since 2019.

  • News  

    Miami business owners arrested for workers' comp fraud, grand theft

    Steve Hallo |

    The business shortchanged its workers’ comp carrier more than $127,000 in premiums by underreporting payroll.

  • Video

    Lights, camera, auto fraud: Scammers caught on video staging accident

    Steve Hallo |

    Home surveillance cameras caught a terrible (and terribly planned) T-bone accident in a residential neighborhood.

  • News  

    Japan penalizes its biggest property insurers for price fixing

    Erica Yokoyama, Nao Sano and Taiga Uranaka |

    The groups being disciplined control around 90% of Japan’s entire P&C market.

  • Commentary  

    Water, water everywhere… but is it fraud?

    Steve Jarrett |

    In many ways, water is the new fire when it comes to insurance fraud.

  • Best Practices  

    Digital, mechanical & physical clues that hint at auto insurance fraud

    Steve Hallo |

    Around 15% of all auto premiums paid are used directly to cover undetected fraudulent claims, J.S. Held reports.

  • News  

    Florida's Citizens Property focus of Senate committee probe

    Saijel Kishan |

    The committee asked whether Citizens has contemplated requesting a federal bailout in the event of being unable to cover its claims.

  • Commentary  

    A song and dance: Why a claims department is no Broadway show

    Max J. Louik, Elizabeth L. Taylor and Katie Rose Kenawell |

    Insurers are in the business of risk transfer, so they should know better than most the risk involved with attorneys performing the same business function as that of a typical insurance adjuster.

  • News  

    Florida adjuster arrested for $11M fraud scheme

    Steve Hallo |

    The adjuster is alleged to have made more than 1,200 bogus payments to 326 co-conspirators. More arrests are expected.

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Resources

  • How to Manage Contact Compliance Without Compromising Outreach

    How to Manage Contact Compliance Without Compromising Outreach

    From gryphon.ai

    Empower your organization to excel in marketing outreach without compromising compliance. This guide offers a roadmap to implement a best-in-class contact compliance strategy so that your organization can continue successful marketing campaigns, ethically and legally.

    Download Resource ›

  • The Comprehensive Marketing Compliance Checklist for 2024

    The Comprehensive Marketing Compliance Checklist for 2024

    From gryphon.ai

    Is your organization protected against costly Do Not Call (DNC) and Telephone Consumer Protection Act (TCPA) violations and fines? This comprehensive checklist explores key compliance areas, offering insights to mitigate risks and protect your brand reputation in 2024.

    Download Resource ›

  • The Enterprise Call Experience in 2023: Insurance

    The Enterprise Call Experience in 2023: Insurance

    From TransUnion

    This report reveals the evolving landscape of insurance communication from 2023 and current trends. Explore insights on multichannel strategies, STIR/SHAKEN call authentication benefits and branded calling in order to enhance your customer experiences in 2024.

    Download Resource ›

  • The State of Customer Outreach: Top Ten Findings for Insurance

    The State of Customer Outreach: Top Ten Findings for Insurance

    From TransUnion

    Download this eBook and learn about challenges, goals and strategies for improving customer experience, revenue growth and operational efficiency. Discover the importance of integrating voice and digital channels, addressing low answer rates and leveraging technology for better customer contact. The study provides insights into insurers' priorities, key challenges and the role of technology solutions in achieving success.

    Download Resource ›

  • Commercial Property Preparedness: Bracing for Changing Risks

    Commercial Property Preparedness: Bracing for Changing Risks

    From OneShield

    Commercial insurers have faced many challenges in 2023 due to a record number of billion-dollar weather events, inflation and a tightening reinsurance market. The increasing focus on individual risk levels in the reinsurance market requires insurers to embrace new technology, data, and tools to improve loss ratios and customer satisfaction. This eBook explores solutions to navigate these challenges and enhance risk management capabilities.

    Download Resource ›

Browse More Resources →

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