One of the most gratifying byproducts of helping claims professionals improve their writing is that they will automatically be more sensitive to fraudulent claims. Many indicators of fraud are based on inconsistency, vagueness, lack of information, and an improper tone—some of the same problems seen in many claims letters. It makes sense that a plain-English claims writer who has addressed issues of vagueness, lack of logic, and inconsistency will apply those observances to questioning the same issues in the actions of a claimant who is writing to obfuscate rather than to achieve clarity.
While many indicators may be obvious to seasoned and well organized communicators, the following list serves as a timely reminder and a useful tool for those seeking to elevate their writing and phone skills to create a more ordered, well phrased and authoritative claim file.
27 Fraud Indicators
- Parties involved are vague on all details
- Documentation provided includes conflicting information
- Same attorney and/or medical provider associated with many accident parties (also known as steering)
- Multiple, similar losses for the same individual
- Reported by an attorney or medical provider with little information
- First report does not match police report
- Supplemental police report appears altered
- Loss within 30 days of policy inception or expiration
- Suspicious theft or fire
- Loss with contact from NICB, law enforcement, or SIU of another insurer
- Claimant is uncooperative/evasive
- Claimant difficult to contact (use of PO box or pager/cell phone number, mail returned undeliverable or unaccepted)
- Claimant is eager to accept blame for an accident, overly pushy or demanding a quick settlement
- Claimant is unusually familiar with medical or insurance terms and/or procedures
- All transactions are conducted in person
- Claimant threatens to engage attorney if loss is not settled quickly
- No police report or over-the-counter police report was filed for accident resulting in injuries and/or extensive physical damage
- Expensive late model vehicle purchased with cash
- Attorney lien letter is dated the day of the accident or shortly thereafter
- Three or more occupants in the vehicle report similar injuries
- All injuries are subjectively diagnosed
- All of the claimants submit medical bills from the same doctor or facility
- Physician's bill and report and/or the treatment plan for various claimants is the same regardless of varying accident circumstances
- Medical bills indicate routine treatment was rendered on Sundays, holidays or other times when most businesses are closed
- An accident involves a vehicle that flees the scene and the claimant can give no identifying information
- Business telephone number is a cell phone or is connected to an answering machine or service
- Claimant refuses to give a recorded or written statement
Be sure to get an examination under oath (EUO) when these indicators of possible fraud are present.
People intent on deception depend on their ability to use words to create a smokescreen. By keeping a keen eye out for known fraud indicators, you'll sharpen your ability to use logic and clear phrasing to combat any effort to disguise unscrupulous intent.
Gary Blake, Ph.D., author of
The Elements of Business Writing, is director of
The Communication Workshop, a company offering customized communications skills training to the insurance community. For a list of seminars and webinars, visit
www.writingworkshop.com.
