Mind Over Matter

Commentary by Garry Slater,
Director of Investigations, Stream Claims Services

Winning the battle against the fraudsters who plague the insurance industry and cost the honest customer hundreds of millions of pounds every year is not simply a question of deploying the latest technology – important as that may be.  Intelligence is key; Database searches and analysis, sophisticated trawling of social media, finding and making the connections between fraudsters as they attempt to disguise their digital footprint and claims history, all have a part to play.

All of these methods, and more are useful support tools in the never ending search for the fraudulent claimant. However, in my view, the modern Loss Adjuster or Investigator working on behalf of their insurer clients must be just as attuned to the nuances of language, consistency of storytelling, and the willingness (or otherwise) of a claimant to be genuinely helpful in resolving a claim.

In one recent example that came across my desk, the claimant maintained that they had lost or had stolen a watch whilst on holiday. We know that this happens in real life and not every claim of this type is necessarily fraudulent. I am a great believer in trusting the customer unless forced to do otherwise by their actions or omissions.

Telling the Truth is Easy

In this instance, though the customer making the claim proved to be extremely reluctant to provide an accurate telephone number for their holiday companion. Attempts to gain this simple piece of information met with a limited response and, eventually, the number provided proved to be incorrect.

Further enquiries did ultimately allow us to interview the friend of the claimant but as you can imagine – our suspicions had been well and truly raised by that point and some additional work on behalf of our insurer client meant that the claim simply ‘disappeared’ and a saving of £4,000.00 was secured – easily, speedily and with little cost.  £4,000.00 doesn’t sound like a lot of money but it is for most people!!

Surprisingly perhaps it was not the use of complex algorithms that spotted the fraudster but a simple set of questions we deployed that are carefully designed to make it easy, to tell the truth – and almost as easy to spot the lie.  After all, millions of people make valid claims every year and they have no hesitation in helping their insurers or loss adjuster to resolve any issues that might arise.

Why would they?

The genuine claimant wants to resolve matters as quickly as possible so that they can get on with their lives. Replacing the genuinely lost watch is actually not something they would ideally like to be doing – because the real claimant would not have wanted to lose the item in the first place!

Of course, the use of sophisticated IT did help us to track down additional relevant information in this case and helped to guarantee that the claim would never progress.

However, I never hesitate to tell my team that the best test you can ever apply is one which involves putting yourself firmly in the shoes of the claimant. Is that how you would behave if you were making a genuine claim in those same circumstances?

If the answer is ‘no’ then you would be well advised to dig a little deeper!