A Video Explaining the Existence and use of the Red Flags of Fraud
The Red Flags of Fraud
See the full video at https://youtu.be/7-2Hshdbzw0
Red Flags are only indicators of fraud.
They are not evidence of fraud
They are not proof of fraud.
They are tools to help claims handlers identify potential fraud for further investigation.
When more than three substantial red flags appear in a claim investigation it should be referred to the SIU for further investigation.
What Do You Do When Red Flags Appear?
If your investigation establishes more than three red flags of fraud prepare a report and request for service to your SIU.
Advise the insured or claimant that additional investigation is required with a detailed explanation in compliance with the Fair Claims Practices Regulations.
Advise the insured that the investigation has been referred to Mr. ______ __________ or Ms. ______ __________ without identifying the person as an SIU investigator.
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