Claims Fraud - An Introduction

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Claims Fraud - An Introduction

• Recent trends within insurance claims fraud

We are going to cover:

Learning Objectives

• How Allianz are responding to and leading the industry response to these challanges

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• EiC Motor Fraud Level One
• EiC Casualty Fraud Level One
• EiC Commercial Property Fraud Level One

This session covers:

Shared knowledge

Insurance Fraud has been a persistent challenge throughout the history of insurance claims.

The Evolution of Claims Fraud

The most recent ABI statistics indicate that insurers detected more than 125,000 fraudulent claims; these frauds were valued at

While motor claims fraud has traditionally been the most prevalent form of claims fraud and the most publicised, the landscape has evolved. Recent years have seen a notable rise in fraudulent claims related to employers' and public liability, as well as developments in pet, engineering, and property claims.

£1.3 billion

Trends

There has been significant rise in dishonest liability insurance claims detected, such as 'slip and trip' cases, which reached 26,900 and were valued at £391 million, marking a 14% rise from the previous year. This reflects the industry’s heightened attention to this area, which has become a growing target for fraudsters. This shift is partly attributed to the Government's crackdown on whiplash and the decrease in legal costs for road traffic accident claims.

Liability Trend

Property Trend

Motor Trend

Click on each of the three headings for more detail.

Dishonest motor claims continued to be the most common and frauds and of highest value , with 70,000 cases detected, representing a slight 2% decrease from the previous year, and a total value of £800 million. This decline is a positive development attributed to enhanced fraud management within the industry, as well as the efforts of the Insurance Fraud Bureau (IFB) and the Insurance Fraud Enforcement Department (IFED).

The value of identified property fraud is continuing to fall but the volume of detected frauds has increased. Organised fraud issues are becoming more prevalent. We are focusing more on the activities of some Loss Assessors.

The Anti-Fraud Structure in Claims Division

James Burge serves as the Claims Fraud Manager and reports directly to the Head of Technical Claims. His primary responsibilities include leading, developing, and communicating Allianz's anti-fraud strategy.

Claims Fraud Manager

Claims Fraud Controllers

Reporting to the Claims Fraud Manager and based in GHO and Milton Keynes CHC, the four Fraud Controllers have the primary responsibility of assisting the Fraud Manager in delivering the anti-fraud strategy.

Identifying emerging trends and threats

Designing and monitor a suitable governance policy for claims fraud investigations that aligns with the business's direction and ethos

Creating and delivering relevant training, both internally and outside of the claims division

Click on each of the icons to find out their other key duties:

Collating and analysing MI to measure savings, expenditures, efficiencies, and other key metrics

Providing technical support and guidance to the Claims Validation Teams

Liaising with other business areas to ensure a joined up approach

Developing, sourcing, and maintaining systems to aid in the detection and investigation of fraud

Oversee the most complex or sensitive fraud cases, including those involving other insurers, such as multiple staged accident investigations

Liaising with support organisations like the ABI Anti-Fraud Committee, the Insurance Fraud Bureau (IFB), and the Insurance Fraud Enforcement Department (IFED), as well as engaging with the market to promote Allianz's offering

Serving as a referral point for fraud invocations

Coordinating referrals to the police and representing Allianz's interests in criminal proceedings

The Anti-Fraud Structure in Claims Division

Based in Birmingham CHC, the Organised Fraud Team (OFCVT) comprises two handlers who report to the Organised Fraud Controller. The OFCVT's primary responsibility is to sift through and analyse data and intelligence across all lines of business. They work closely with the Insurance Fraud Bureau (IFB) and ensure that all pertinent information is disseminated to the Claims Validation Teams.

Organised Fraud Team

Fraud Co-ordinators/ RI Champions/ CVT Buddies

Fraud Co-ordinators (FCOs) are currently based in Birmingham CHC, while RI Champions or CVT Buddies are located in Milton Keynes CHC. Despite the different titles, their roles are very similar: to assist in identifying claims that display Risk Indicators and refer them to the Claims Validation Teams (CVTs). To aid in this identification, they will:

• Promote local awareness, deliver training, and disseminate data
• Act as designated referral points for claims handlers, facilitating onward referrals to the CVT Team
• Record potential fraud in systems such as Coronet or Tiara/Tia (Risk Indicator)
• Support claims handlers with basic desktop inquiries

The Anti-Fraud Structure in Claims Division

Proactive Referrals

Claims Validation Teams (CVT's)

The primary responsibilities of the CVTs are to:

• Validate claims flagged with concerns through thorough and detailed investigations, ensuring ethical and compliant practices
• Challenge claims that do not pass the validation process
• Achieve savings on claim expenditures by withholding payments on claims with evidence of fraudulent activity
• Pursue appropriate remedies for proven fraudulent claims, including criminal prosecutions where applicable

The profile of the work within the CVT is made up of reactive and proactive referrals: Click on the below for more informaion

Reactive Referrals

Claims Validation Teams (CVTs) are located in various centers:

Milton Keynes CHC handles motor, casualty, household, and commercial property claims; Birmingham CHC focuses on motor trade claims; and Brentford has claims validation handlers specialising in animal health.

Why Do Allianz have a Claims Fraud Response?

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The simple answer is that is the right thing to do and we have an absolute duty to protect our honest customers. We will always strive to provide excellent claims service and ensure that genuine claims are paid as quickly as possible. However, fraud remains a significant threat to the insurance industry.As a member of the Association of British Insurers (ABI), Allianz shares a strong commitment to combating insurance fraud. In 2023 alone, we achieved claims fraud savings totaling £77.4 million, funds that were not paid out to suspected fraudulent policyholders and claimants.To further enhance our efforts, we encourage you to complete the EIC Fraud Level Two Pathway modules. These modules are specifically designed to improve your technical skills and assist in the identification of fraudulent claims. For CVT handlers, the practical handling guidance included in these modules will be particularly beneficial for the day-to-day management of suspected fraudulent claims.

Your dedication to this cause is crucial, and together, we can continue to protect our honest customers and uphold the integrity of our industry.

Let's see what you remember!

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Let's see what you remember!

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The __________ work involves cases where a handler has raised concerns about a claim to their __________________ or RI Champion in their respective CHC.

fraud co-ordinator

colleague

team leader

fraud co-ordinator

reactive

majority of

reactive

proactive

FILL IN THE BLANKS

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Claims Fraud - An Introduction

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The reactive work involves cases where a handler has raised concerns about a claim to their Fraud Coordinator or RI Champion in their respective CHC. The Fraud Co-ordinator or RI Champion assesses the nature of these concerns and conducts basic desktop inquiries to eliminate cases with easily explained discrepancies. If the discrepancies cannot be validated, the case is then referred to the Claims Validation Team (CVT).

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Proactive referrals involve cases identified as potentially fraudulent based on intelligence pinpointing specific key attractors. These key attractors can range from individuals to addresses or credit hire providers and may be identified by internal sources (such as a handler) or external sources like the Insurance Fraud Bureau (IFB). Markers are then attached to any claim in Claims Centre or on COA that involves the identified key attractors.