Finance and Treasury

Insurance Claims Investigation and Fraud Indicators

An insurer that pays every claim quickly loses money and one that resists them loses customers, and the skill sits in deciding which claims warrant scrutiny before the file has consumed the difference. This course builds that judgement. Delegates work through policy response, establishing whether the loss falls within cover before investigating anything else. Loss adjusting principles follow, including quantum, indemnity and betterment. Investigation technique is covered: scene evidence, documentation, third party accounts and the timeline that either holds together or does not. Fraud indicators are addressed specifically by class, including staged motor accidents, inflated contents claims and losses that occur suspiciously close to inception or lapse. Interviewing a claimant fairly is practised, with the limits on what an insurer may do. Repudiation and its communication are covered, since a badly explained decline creates a complaint. Salvage, subrogation and recovery follow. The course closes on complaints, ombudsman referral and litigation.