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Health check on Fraud Management within Insurance sector

Health check on Fraud Management within Insurance sector. CILA Presentation by Anti-Fraud SIG. John Freeman 30th October 2007. Fraud and the insurance industry Research results January 2001. Professor Alan Doig and Professor Michael Levi Principle recommendations;

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Health check on Fraud Management within Insurance sector

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  1. Health check on Fraud Management within Insurance sector CILA Presentation by Anti-Fraud SIG John Freeman 30th October 2007

  2. Fraud and the insurance industryResearch results January 2001 Professor Alan Doig and Professor Michael Levi Principle recommendations; • Establish common definitions for fraud measurement • Formal protocols with the police • Public surveys • Requirement and scoping exercise, undertaken across industry databases • Create Industry wide fraud resource • Information sharing protocols • Increase professionalism within the investigation arm of the insurance industry

  3. Common definitions for fraud measurement Response ABI definitions agreed and data being reported Three broad categories: • Fictitious losses, incidents or injuries • Staged incidents • Material misrepresentation or exaggeration of losses or personal injury Returns based on: • Proven insurance fraud • Suspected insurance fraud

  4. Formal protocols with the police

  5. Public Surveys • ABI Public surveys • Focus Group sessions • Commercial Fraud Survey • Host of Industry Surveys

  6. User requirement and scoping exercise to be undertaken • ABI Polaris project • Objective to develop common standards and common data access protocols • Accessing CUE, MIAFTR,MID etc on one common platform • Streamlined and efficient use of technology to deliver industry data requirements

  7. Create industry-wide fraud resource • Insurance Fraud Bureau • Focus on distributed claims fraud, through which organised criminals make multiple, fraudulent insurance claims across many insurers. • Detica under contract will apply a series of advanced, new data analysis techniques to detect patterns of fraudulent behaviour in huge volumes of claims data supplied to the IFB by UK insurers. • £3.4 Million contract will be run as a managed service, Detica to supply fraud intelligence on an ongoing basis to internal team of insurance fraud case managers.

  8. Agree information sharing protocols Insurance Fraud Investigators Group – committee role is to: National Intelligence Model provides:

  9. Increase professionalism of investigators

  10. Conclusion • Substantial progress since original report in all areas • Need to do more in the market to publicise the fact • Must not become complacent • Challenging times ahead • Danger of compartmentalising strategy • Holistic solution must be the end objective

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