Life insurance claim investigations

Insurance companies should be wary of the various types and modes of insurance fraud. Starting from the falsification of personal documents and the insured’s name and profile, mark-ups, to even the falsification of death certificates—as in the case that took place last June.

A man, along with his friends, plotted to fake his death for a Rp 3 billion insurance payout. In brief, he and his buddies fabricated a scenario of a car accident that would result in him falling into the river and vanishing.

One of the friends then reported that he drowned to police, claiming that his body could not be found. In response to this claim, the insurance company conducted an inquiry before determining its validity and making the payout.

Subsequently, the matter was investigated by the police. The authorities established that the criminal had faked his death—he had not drowned but had escaped and was presumed dead.

A similar incident took place near the end of 2020. To obtain an insurance payout, a man faked his wife’s death by creating a fake death certificate. However, this scheme failed and the couple’s case landed in court.

The importance of claim investigations

In general, if a claim must be paid, the insurance company must perform an investigation to verify the information received to prevent insurance fraud.

As an illustration, the loss incurred due to insurance fraud is significantly greater than the costs to cover genuine claims. A source noted that the losses faced by insurance companies in the UK due to insurance fraud throughout 2021 amounted to more than £122 million.

Investigations following death claims include (among others) verification of the death certificate, the certificate of burial evidence, the death certificate from the police (if they died due to an accident), and all submitted claim documents.

Simply verifying existing written data is not enough—a more comprehensive analysis of insurance claims is also required. In theory, information can be gathered directly or indirectly.

Indirect information searches involve scanning databases, reviewing media, and verifying the authenticity of claim letters, among other things. Meanwhile, a direct search for information can be conducted through interviews with relevant sources, such as neighbors, the hospital where the insured was reportedly treated, the insured’s workplace, and so on.

The need for experts

Experts are required to undertake thorough investigations of insurance claims. These trained professionals have developed their skills and are able to determine which techniques should be used to uncover evidence efficiently.

With over twenty years of expertise, customers from various industry backgrounds have trusted Integrity Asia to deliver corporate investigative services. This includes claim investigations.

Using strategies and methods to uncover the truth behind fraudulent claims, our team of professionals will verify each claim and conduct in-depth investigations to expose evidence of questionable claims.

Please contact us for additional details about claim investigations.

Putri
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