Tools Available to Insurers to Fight Fraud Unlisted Video

The Special Investigative Unit

California, Washington, New Jersey, and Florida are among many states that require each insurer to have an SIU in place.  SIUs help identify and investigate suspicious claims, although some insurance companies outsource this work to other insurers and investigative agencies. An SIU may be a small team whose primary role is to train claim representatives to deal with the more routine kinds of fraud cases or may consist of teams of trained investigators, including former law enforcement officers, attorneys, accountants, and claim experts who work together to investigate fraudulent activities thoroughly. More complex cases, involving large-scale criminal operations or individuals who repeatedly stage accidents, may be turned over to the NICB.

In some cases, the SIU has grown to be a multifaceted organization whose duties are not limited to the investigation of fraudulent claims.

Depending on the way it is organized, the SIU’s work as an integral part of an anti-fraud program that includes the following:

investigation of potentially fraudulent claims;
education of claims and underwriting personnel about how to recognize potential fraud;
education of the public about how insurance fraud affects the average insurance buyer; and
liaison with fraud division, police, and prosecutorial agencies.
The CFE

The Certified Fraud Examiner (CFE) is a fraud-fighting professional.  The Association of Certified Fraud Examiners is an international, 25,000-member professional organization dedicated to fighting fraud and white-collar crime.  It was established in 1988, and is based in Austin, Texas.  With offices in North America and chapters around the globe, the Association is networked to respond to the needs of anti-fraud professionals everywhere.

The Expert Attorney

When an insurer suspects fraud, it will usually ask an attorney to get involved.  Attorneys who are retained in such situations are specialists who have either received specialized training or have sufficient experience concerning fraud and the evidence necessary to prove fraud to handle these cases.  Many are CFEs and all make it a practice to attend continuing education classes that relate to fraud issues.

The role of the expert attorney varies depending on the type of claim where fraud is suspected.

© 2021 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;  Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts; and the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/  podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4