Ageas UK’s Post

We are thrilled to spotlight our collaborative effort with Ageas UK in our joint fraud mitigation strategy, a pivotal initiative launched in the latter half of 2022. This partnership has been instrumental in addressing the surge in Escape of Water (EOW) claims, a challenge echoed across the insurance industry. Traditionally, lower-value EOW claims have posed significant hurdles in fraud detection due to the intensive resources required versus the potential savings. However, by harnessing the power of our Synergy Cloud platform alongside Ageas’s sophisticated machine-learning models, we have dramatically enhanced our fraud detection capabilities. The results speak for themselves—a 140% increase in detected fraudulent EOW claims in the first half of 2024 compared to the same period in 2022. This achievement not only sets new benchmarks in fraud prevention but also ensures quicker, more accurate claim resolutions, safeguarding customer satisfaction and trust. We are proud to share that this initiative has been shortlisted for the Excellence in Fraud Mitigation category at the upcoming Insurance Times Awards. This recognition is a testament to the hard work and dedication of both teams. #InsuranceTimesAwards #FraudMitigation #customerservice Jeremy Hyams #insurance #claims #claimsmanagement

As part of the fraud detection mechanism, IRDAI has proposed that insurance companies should do background checks for any adverse records of their agents and intermediaries to curb instances of fraud. IRDAI has also proposed that insurers should put in place a mechanism to analyse customer complaints against distribution channels. Insurers should also do scrutiny of distributors in case of high policy turnover rates or unusual patterns of policy cancellations and reissuances among other things. IRDAI has further proposed to monitor the performance and business trend of their agents and intermediaries. Overall, in its draft circular, IRDAI has identified four types of frauds in the insurance industry – Internal fraud, distribution fraud, policyholder fraud or claims fraud and external fraud. ▪️Internal fraud happens when a policyholder or internal staff, alone or in collusion with others does fraud. It includes misappropriating funds or assets, forgery and so on ▪️Distribution channel fraud is fraud done by agents or intermediaries by misrepresentation of policy features, premium siphoning and forgery of documents, fabrication of information and non-disclosure of material facts ▪️Policyholder fraud happens through policyholders to obtain coverage, get claim with an intent to deceive the insurance companies ▪️External fraud is carried out by external parties and vendors like cybercrimes Here are some key highlights of the draft circular on fraud detection monitoring framework: ▪️Insurers to have in place a well document policy to implement fraud risk management strategy to proactively address potential fraud ▪️Insurers should have appropriate fraud risk governance framework to deter, prevent, detect, monitor and mitigate insurance frauds ▪️Insurers will also have to place board approved anti-fraud policy by considering business risk, risk profile and establishing essential checks and controls. Such a policy has to be reviewed annually ▪️Insurers should educate policyholders and general public about the consequences of insurance fraud to mitigate the policyholder frauds ▪️For external frauds, insurers can implement due diligence of vendors and service providers #sign #irdai #BGV #insurance

Today the Association of British Insurers (ABI) released its detected fraud figures for 2023. As the ABI (rightly) highlight on their website, 'this information provides an indication of the level of detected fraud impacting on the insurance industry as a whole. Individual insurers have their own mechanisms for understanding their own exposure to fraud and taking steps to mitigate the related risks'. 👉 £1.1 billion was the value of detected fraudulent claims in 2023. 👉 This figure has remained flat over recent years. 👉 Whether it is £1.1 billion or more, it remains an expensive industry issue. 👉 The frequency and value of undetected fraud is obviously an unknown. 👉 Motor insurance fraud accounted for 54% of the figures. 👉 Good to see inclusion of 583,000 detected instances of application fraud. It would be helpful to include the below in the annual industry reporting, as it would further support the industry messaging and promote the value of holistic counter fraud strategies: ✅The estimated financial value of the detected application fraud; and ✅The lines of business. ✅ Reference to organised fraud by frequency and value. ✅ Supply chain fraud. ✅ Successful prosecutions by number, incident types and outcomes. Motor insurance fraud again features in the highest detection figures. Does this represent a line of business most exposed to fraud, and or where the greatest investment has been made in fraud mitigation? 🚦With the level of investment in technology - including the availability of AI and now extended to include GenAI, data enrichment and cross-industry controlled data sharing, logically successful fraud detection should be on an upward trajectory. Therefore, when there is reference to an increase in fraud detection, it's not always clear whether the industry is getting better at detection, or the frequency of fraud is growing. Perhaps a combination of both. It would be difficult in the current financial climate and with the long-tail impact of the pandemic, to see the fraud risk reducing. Certainly, counter-Fraud Strategy maturity significantly varies across the industry and there is no shortage of opportunities to raise the bar and challenge the status quo. We have been in an on-demand online world for some time now, which suits fraudsters. If counter-fraud strategies are not fully aligned to this, it will prove very costly.

Alphatec ClaimControl: Stop Fraud in Its Tracks! Insurance fraud is a major issue, costing insurers billions and driving up premiums for everyone. A recent youTalkinsurance article advised that Aviva detected a staggering 39% more fraud in 2023 compared to 2022! So, what do you do to identify and combat fraud? Fraudulent claims come in many forms, from staged accidents to inflated repair costs. These can be difficult to detect, but Alphatec ClaimControl can help. ClaimControl offers a powerful suite of tools to fight fraud, including: ✅ Red flag identification: Built-in features that highlight suspicious patterns and inconsistencies. ✅ Data analysis: Powerful reporting that helps you identify trends and potential fraud. ✅ Integration with external databases: Cross-check claimant information for accuracy. ✅ Configurable fraud monitoring: Tailor the system to target specific areas of risk. In addition to ClaimControl, here are some best practices to fight fraud: ✅ Educate staff: Train claims handlers on the latest fraud schemes. ✅ Implement strong internal controls: Clear procedures and whistleblower policies deter fraud. ✅ Maintain accurate documentation: Detailed records help identify inconsistencies. Check out our blog post 👇🏻for a deeper dive into the hidden costs of fraud and how ClaimControl can help: https://lnkd.in/eghfGwWu #insurancefraud #claimsmanagement #frauddetection

Enforcing your zero fraud commitment starts with a robust fraud policy.

https://lnkd.in/e4sPGZs3 Key takeouts from the latest #insurancefraud figures released by the Association of British Insurers: 💥 £1.1 billion worth of fraudulent claims detected in 2023, up 4% on 2022.   💥 Insurers identified 84,400 fraudulent claims in 2023 (😵 that's 231 claims a day), 11,800 more than in 2022. . 💥 Exaggerated loss (a deliberate attempt to increase the cost of a claim beyond its true value), was the most common type of fraud with 25,700 claims amounting to £407 million. 💬 This is the tip of the iceberg, as the figures relate to claims that are 🔎 detected. ❓ Think about how many claims slip through the net, resulting in the fraudsters and scammers benefitting financially to the detriment of honest customers. At Collinson Insurance our Counter Fraud Team: Invests 🕜 time in our 👨💻 👩💻 people through an ongoing fraud 👀 awareness programme, regular training and mentoring of our fraud 🏆champions. Awareness isn't just restricted to how everyone understands how they can help to 🛡 protect the business from opportunistic and organised syndicate fraud, but also how each of us can 🛡 protect ourselves in our day-to-day lives. Implements and regularly reviews 📄 processes and 🛑 controls that are effective, proportionate and understood by everyone. We also strive to ensure that the 🚄 journey for our genuine, honest and loyal customers isn't interrupted, so their claims are administered ✔ quickly, ✔accurately and ✔fairly. Identifies and invests in ⌨ technology that is accurate, effective and is aligned to ✈ 🚑 😁 📱 the lines of business we operate in. And not forgetting how we 🧡 collaborate with our counter fraud peers. #insurancefraud #fraudawareness #collaboration

Fraud - how does your Claims Management System manage this? Is our latest blog of interest..... #claimsmanagement #identifyfraud #SaaSsolutions

Are we seeing increasing regulator focus on fraud - and the need for sectors and firms to evidence collaboration? And what does this mean for insurance? Call out to Sally Felton for posting this on LinkedIn yesterday. The FCA review of firms use of the Cifas NFD does indeed make a fascinating read. A few paras that stand out to me: -> The recognition that data sharing is key to combatting fraud and protecting victims -> Specific review on the firms that are (or are not) proactive on participating in - and submitting data into - shared fraud databases -> And the association of data sharing to the NFD to effective systems and controls for the prevention of fraud. Yes, this review concerns the high profile enabler of money mules. But well worth considering: -> The overall direction of travel from anti money laundering focus to wider fraud -> The recognised value of participating in fraud data sharing to protect consumers -> How this links to insurance fraud - both in terms of accounts being the source of insurance fraud (ghostbroking or serial application fraud) or conduit of proceeds through private and business accounts. (Are our FS sectors joined up sufficiently) -> And ramifications for the insurance sector - participation in the sectors fraud utilities and how this will be a focus of the Insurance Fraud Charter commitments All in all, more than just interesting - and a must read for fraud leaders in insurance.

⛔ Deceptive Deals: Unveiling Insurance Fraud The insurance industry, built on principles of trust and security, occasionally faces challenges that test its integrity. The case involving Atul Shah and Mahaveer Kankariya stands as a stark reminder of such challenges. Perpetrated against Lloyd's of London, their sophisticated fraud scheme exposed critical vulnerabilities within insurance practices, prompting a necessary reassessment of protocols and a call for heightened vigilance against fraudulent activities. 📄 Identifying the Loopholes ⚠️Inadequate Verification Processes: Insufficient checks on claims and supporting documents enable fraudsters to submit false or exaggerated claims unnoticed, often due to manual processes lacking rigorous scrutiny. ⚠️Lack of Data Analytics: Without advanced technology and robust data analytics, insurers struggle to detect suspicious patterns in claims data, making it easier for fraudsters to manipulate information and avoid detection. ⚠️Complexity in Policies and Claims: The intricate nature of insurance policies and claims processes creates opportunities for fraudsters to exploit confusion and ambiguity, whether through unintentional misunderstandings or deliberate misrepresentation. ⚠️Poor Internal Controls: Weak internal controls within insurance companies, such as inadequate segregation of duties or oversight, allow fraudsters to exploit system vulnerabilities. ⚠️Collusion and Insider Fraud: Instances of collusion between employees, agents, and external parties go unchecked due to insufficient monitoring, background checks, or enforcement of ethical standards. ⚠️Claims Leakage: Ineffective claims management processes result in claims leakage, where legitimate claims are improperly handled, providing opportunities for fraudulent activities. ⚠️Regulatory Gaps and Enforcement: Inadequate regulatory oversight and enforcement of anti-fraud measures diminish the perceived risk of detection and punishment for fraudsters, exacerbating the problem. Additionally, the complexity and volume of insurance transactions can overwhelm oversight mechanisms. Insufficient internal controls and monitoring can inadvertently facilitate fraudulent activities. ✅Lessons for Insurers Insurers must invest in advanced analytics and technology to identify suspicious patterns and anomalies in claims data. Automated systems can flag irregularities in real-time, enabling prompt investigation and mitigation of potential fraud. Moreover, fostering a culture of integrity and ethical conduct within the organization is paramount. Training employees to recognize red flags, promoting whistleblowing mechanisms, and conducting regular audits can significantly bolster fraud prevention efforts. #InsuranceFraud #FinancialCrime #FraudPrevention #InsuranceClaims #LloydsofLondon