Insurers choose detectives and experts in fraud detection

ICEA (Cooperative Research between Underwriters and Pension Funds), in its report on the Spanish Insurance Fraud 2011 presented by shows that is increasing the attempted insurance fraud, reaching 95,312 in the car insurance industry, which an annual increase of 10.5%.But who is behind the fraud?"Virtually all cases are detected correspond to individuals.

The amount claimed by case usually low," says a director of ICEA, more worrisome considering the action of organized gangs. "They represent a small volume of cases in each scam but manage to get much more relevant quantities. Primarily active in the auto industry."Almost always, it is the insured who is committing fraud.

The role of contrast is relevant only in car accidents (22%). And neither mediators nor insurance providers (shops, doctors, builders ...) are often involved in the scams.The best case of fraud detectedICEA convenes an annual contest to choose the juiciest deception. The fraud prevention departments of the first Spanish insurance refer more curious cases have been detected at ICEA.

The jury weighs both the economic quantity that has saved the insurer to discover the thymus as detection techniques employed and the strength of evidence.In the case that won first prize last year, coordination of parallel investigations was fundamental. We detected a possible fraud in an incident in which a person became paraplegic due to a car accident. The insurer suspected that the claimant had posed as copilot, when it really was the driver of the vehicle at the time of the accident.In the auto insurance policies to third parties, the driver of the car is not covered, but the companions.

The combined action of the company's experts, an engineering center that reconstructed the accident sequence and specialists of forensic medicine chair failed to prove at trial that the accident was driving the car at the time of the incident.Is it profitable for insurers to avoid scams?Sometimes the cure is worse than the disease, but overall it is very beneficial. The key lies in knowing the companies decide when and in what compensates investigate is less expensive to overlook ...Last year, the 21 entities that contributed to the study ICEA fraud allocated 6.7 million euros to analyze possible scams. This investment allowed avoiding scams where net demanded payment of 341 million euros in compensation. For every dollar spent on research is avoided paying almost 52 euros.

To uncover the deceptions insurers mobilize their experts, who are responsible for evaluating the origin of the claim and the amount of damages. They also hire the services of private detectives. Their job is to contrast the documentation provided and the accounts presented by those involved in the incident. Sometimes, companies turn to specialized laboratories to analyze samples collected at the scene.

The technological sophistication also extends in fraud detection activities, resulting in a massive increase use of internet and social networks for monitoring and investigation of claims. Internet helps to reveal if there are any pre-existing relationship between the cause of the accident and the injured. There have been cases where those involved in a traffic collision when they were denied knowing clearly in contact on social networks.The Data Protection Act has cut so far all projects to create an official file insurance fraudsters. However, it is common practice for insurance servicers hold data of families who have tried to cheat in the last sector.