Modern Insurance Magazine Issue 62: The Fraud Supplement
This issue features... Interview: A Catalyst for Action, with Ursula Jallow, Director, Insurance Fraud Bureau (IFB) Interview: IFED: 'Collaboration At Its Finest', with DCI Tom Hill, Head of the Insurance Fraud Enforcement Department (IFED), City of London Police Digilog: Q&A with Lior Koskas, CEO Verisk: Delivering a Great Customer Experience and Detecting Fraud Doesn't Have to Be a Double Edged Sword Carpenters Group: Catching Up with Donna Scully, Director FRISS: Enhancing Special Investigations: The Role of Modern Case Management in Insurance Whitelk: Q&A with Matt Gilham, Director Crawford & Co: Fraud Recovery Litigation: A Powerful Tool in the Fight Against Insurance Fraud SAS: Q&A with Paul Ridge, Head of Insurance - UK Mind Foundry: AI vs. Fraud LexisNexis: Insurance Providers can be First Responders in the Fight Against Fraud Charles Taylor: An Entire Fraud Ecosystem DLB Investigations: Navigating the Complexities of Insurance Fraud in the UK and Unmasking Current Trends Cifas: How can the Insurance Industry Manage the Internal Risk of Fraud?
This issue features...
Interview: A Catalyst for Action, with Ursula Jallow, Director, Insurance Fraud Bureau (IFB)
Interview: IFED: 'Collaboration At Its Finest', with DCI Tom Hill, Head of the Insurance Fraud Enforcement Department (IFED), City of London Police
Digilog: Q&A with Lior Koskas, CEO
Verisk: Delivering a Great Customer Experience and Detecting Fraud Doesn't Have to Be a Double Edged Sword
Carpenters Group: Catching Up with Donna Scully, Director
FRISS: Enhancing Special Investigations: The Role of Modern Case Management in Insurance
Whitelk: Q&A with Matt Gilham, Director
Crawford & Co: Fraud Recovery Litigation: A Powerful Tool in the Fight Against Insurance Fraud
SAS: Q&A with Paul Ridge, Head of Insurance - UK
Mind Foundry: AI vs. Fraud
LexisNexis: Insurance Providers can be First Responders in the Fight Against Fraud
Charles Taylor: An Entire Fraud Ecosystem
DLB Investigations: Navigating the Complexities of Insurance Fraud in the UK and Unmasking Current Trends
Cifas: How can the Insurance Industry Manage the Internal Risk of Fraud?
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“<strong>Insurance</strong> fraud<br />
is a dynamic beast”<br />
Donna Scully, Carpenters Group<br />
Enhancing Special<br />
Investigations:<br />
<strong>The</strong> Role of <strong>Modern</strong> Case<br />
Management in <strong>Insurance</strong><br />
Catching Up<br />
with Donna Scully,<br />
Carpenters Group<br />
A Catalyst<br />
for Action<br />
with Ursula Jallow, IFB<br />
<strong>Fraud</strong> Recovery<br />
Litigation:<br />
A Powerful Tool in the Fight<br />
Against <strong>Insurance</strong> <strong>Fraud</strong><br />
IFED:<br />
‘Collaboration<br />
at its Finest’<br />
with DCI Tom Hill
WELCOME<br />
Amelia Barlow, Editor<br />
<strong>Fraud</strong>ulent activity within the<br />
insurance industry is a tale as old as<br />
time. However, modern advancements<br />
in technology, coupled with a cost-ofliving<br />
crisis and economic headwinds<br />
around the globe, have undoubtedly<br />
created a lively present day fraud<br />
landscape.<br />
In our eagerly anticipated ‘<strong>Fraud</strong> themed’<br />
supplement magazine, we’re delighted to explore<br />
this matter further in conversation with Ursula Jallow,<br />
Director of the <strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB). You’ll<br />
find the full transcript of our discussion on p.4,<br />
where we chat about the success of some recent<br />
public awareness campaigns, the wider evolution<br />
of insurance fraud, as well as the developing role<br />
of technology in the detection and prevention of<br />
fraudulent activity.<br />
I was also delighted to sit down with DCI Tom<br />
Hill, Head of the <strong>Insurance</strong> <strong>Fraud</strong> Enforcement<br />
Department (IFED) at the City of London Police,<br />
to discuss the role of the criminal justice system in<br />
deterring fraud, the efficacy of existing legislation, as<br />
well as the significance of the industry’s collaborative<br />
efforts in the ever-present fight against fraud. Catch<br />
the full interview on p.6!<br />
I am so grateful for the unique insights of our<br />
valued contributors, all of whom bring their skills,<br />
knowledge and enthusiasm to the fore in order<br />
to present us with a series of perceptive thought<br />
leadership articles and astute Q&A interviews.<br />
Rachael Pearson, Project Manager<br />
Of course, I would warmly welcome your feedback<br />
across all relevant channels using the details below.<br />
Until next time, however, happy reading!<br />
Amelia Day Barlow<br />
Editor<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong><br />
@Amelia<strong>Modern</strong>Ins<br />
amelia@charltongrant.co.uk<br />
Rachael Pearson<br />
Project Manager<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong><br />
rachael.pearson@charltongrant.co.uk<br />
2 <strong>Fraud</strong> <strong>Supplement</strong>
INTERVIEWS<br />
4<br />
6<br />
A Catalyst for Action, with Ursula Jallow, Director of the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB)<br />
In such a dynamic risk landscape, fighting insurance fraud is<br />
increasingly vital. <strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> recently sat<br />
down with Ursula Jallow, Director of the <strong>Insurance</strong> <strong>Fraud</strong><br />
Bureau, to discuss the evolution of insurance fraud, recent<br />
public awareness campaigns, as well as the developing role<br />
of technology in the detection and prevention of fraudulent<br />
activity.<br />
IFED: ‘Collaboration at its Finest,’ with DCI Tom Hill, Head of<br />
the <strong>Insurance</strong> <strong>Fraud</strong> Enforcement Department (IFED) at City of<br />
London Police<br />
Tackling insurance fraud often requires both public and private<br />
sectors to work in harmony together. <strong>Modern</strong> <strong>Insurance</strong><br />
<strong>Magazine</strong> recently caught up with DCI Tom Hill, Head of the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Enforcement Department (IFED) at the City<br />
of London Police, to discuss the impact of recent awareness<br />
campaigns, the efficacy of existing legislation, and the<br />
significance of the industry’s collaborative efforts in the everpresent<br />
fight against fraud.<br />
FEATURES<br />
8<br />
11<br />
14<br />
17<br />
20<br />
Q&A with Lior Koskas, Digilog UK<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> catches up with Lior Koskas, CEO<br />
at Digilog, to discuss the benefits of their innovative technology,<br />
the accredited training courses on offer, and their recent <strong>Fraud</strong><br />
Supper Club at Home Grown, London.<br />
Delivering a great customer experience and detecting fraud<br />
doesn’t have to be a double-edged sword<br />
Digital automation has brought many gains to our industry,<br />
including an enhanced customer experience and increased<br />
insurer efficiency. However, these advantages have come at<br />
a cost, with a significant increase in the volume of fraudulent<br />
claims. Kaye Sydenham, Product Owner - Anti-<strong>Fraud</strong> at Verisk,<br />
reports.<br />
Catching Up with Donna Scully, Carpenters Group<br />
Carpenters Group are setting a gold standard for industry<br />
collaboration in the fight against insurance fraud. We recently<br />
caught up with their Director, Donna Scully, to further discuss<br />
her role in this process, the education of Carpenters Group case<br />
handlers, and the significance of an affiliate membership to the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Bureau.<br />
Enhancing Special Investigations: <strong>The</strong> Role of <strong>Modern</strong> Case<br />
Management in <strong>Insurance</strong><br />
FRISS work with P&C insurers to provide the most implemented<br />
solution for trust automation across the full policy lifecycle.<br />
Martyn Griffiths, Sales Manager UKI, reports on the role of<br />
modern case management in the insurance industry, looking at<br />
the capabilities that all insurers should be looking out for in a<br />
successful fraud case management solution.<br />
Q&A with Matt Gilham, Whitelk<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> catches up with Matt Gilham,<br />
Director of Whitelk, to draw upon his vast knowledge of fraud<br />
prevention in insurance. In this exclusive Q&A, we discuss fraud<br />
prevention strategies, digital transformation, and the impact<br />
of Artificial Intelligence (AI) and Machine Learning (ML) on the<br />
insurance fraud landscape.<br />
23<br />
26<br />
28<br />
31<br />
34<br />
36<br />
38<br />
<strong>Fraud</strong> Recovery Litigation: A Powerful Tool in the Fight<br />
Against <strong>Insurance</strong> <strong>Fraud</strong><br />
In most fraudulent claims, there are usually two key drivers<br />
- need and greed. Peter Oakes, Head of Counter <strong>Fraud</strong><br />
at Crawford & Company, discusses how the economic<br />
uncertainty of recent times has driven cases of opportunistic<br />
fraud.<br />
Q&A with Paul Ridge, SAS<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> caught up with Paul Ridge,<br />
Head of <strong>Insurance</strong> – UK at SAS, to discuss the amplified risk<br />
of fraud in light of increasing digitisation across the industry,<br />
the pressures that <strong>Fraud</strong> Investigation Teams are facing at<br />
the moment, and some key findings from the recent Coalition<br />
Against <strong>Insurance</strong> <strong>Fraud</strong> survey.<br />
AI vs. <strong>Fraud</strong><br />
<strong>Fraud</strong> is a constantly changing threat to the insurance<br />
industry, with a significant impact on the bottom line,<br />
customer satisfaction, and society as a whole. Selim<br />
Cavanagh, Director of <strong>Insurance</strong> at Mind Foundry, considers<br />
how AI might just hold the key to effectively combatting<br />
fraudulent activity within the insurance industry.<br />
<strong>Insurance</strong> Providers can be First Responders in the Fight<br />
Against <strong>Fraud</strong><br />
Martyn Mathews, VP personal and commercial lines, UK and<br />
Ireland, reports for LexisNexis Risk Solutions, <strong>Insurance</strong>,<br />
looking at how we can balance fraud with the effective<br />
assessment of risk and customer service excellence.<br />
Charles Taylor: ‘An entire fraud ecosystem’<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> catches up with Bobby Gracey,<br />
Global Head of Counter <strong>Fraud</strong> at Charles Taylor, to discuss<br />
their inimitable blend of human skill and automation, their<br />
widespread product offering, and their unique approach to<br />
fraud investigation across multiple aspects of insurance.<br />
Navigating the complexities of <strong>Insurance</strong> <strong>Fraud</strong> in the UK<br />
and Unmasking Current Trends<br />
<strong>Insurance</strong> offers protection and peace of mind to millions<br />
of individuals and businesses. However, the insurance<br />
landscape in the UK is not without its challenges, one of the<br />
most significant being motor insurance fraud. David Booker,<br />
Managing Director at DLB Investigations Ltd, elaborates.<br />
How can the insurance industry manage the internal risk of<br />
fraud?<br />
Employees within the insurance sector are no different<br />
to any other sector when it comes to dishonest conduct.<br />
Tracey Carpenter, Insider Threat Manager at Cifas, explains<br />
how organisations can put the relevant defences in place to<br />
protect against the insider threat of fraud.<br />
Contributed by<br />
<strong>Fraud</strong> <strong>Supplement</strong> 3
A Catalyst for Action<br />
In such a dynamic risk landscape, fighting insurance fraud is increasingly vital.<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> recently sat down with Ursula Jallow, Director of the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Bureau, to discuss the evolution of insurance fraud, recent public<br />
awareness campaigns, as well as the developing role of technology in the detection<br />
and prevention of fraudulent activity.<br />
QHi Ursula, thanks so much for your time today!<br />
You have been working in the insurance industry<br />
and fighting financial crime for over 25 years now<br />
- a fantastic achievement! How have you seen the<br />
intricacies of insurance fraud evolve throughout this<br />
time?<br />
AI wouldn’t say that the nature of fraud has inherently changed much.<br />
However, insurers are now a lot better at recognising fraud, and<br />
the societal evolution of digital advancements has enabled the same<br />
fraud to occur, but in different ways.<br />
<strong>The</strong> industry is much better equipped to deal with fraudulent activity than<br />
it ever has been. In the past, very few insurers had dedicated fraud teams,<br />
let alone systems to detect it. However, the majority of insurers now have<br />
this monitoring in place; they’re funding the <strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB)<br />
and they’re funding the <strong>Insurance</strong> <strong>Fraud</strong> Enforcement Department (IFED),<br />
a specialist branch of City of London Police. <strong>The</strong> industry’s commitment to<br />
protect innocent consumers has come on leaps and bounds, despite the fact<br />
that fraudulent activity inherently remains the same.<br />
Fundamentally, the digital perspective has been our primary catalyst for<br />
action. One third of our cases under investigation right now relate to ghost<br />
brokers, and we all know that this type of criminal predominantly operates<br />
through the use of social media platforms. Police forces around the country<br />
are encountering the same issue, beyond fraud and into wider aspects of<br />
criminal activity as well. It can’t be ignored, and as an industry, we are really<br />
focused on getting better at managing the type of fraud that digital platforms<br />
facilitate.<br />
QYou were permanently appointed Managing Director<br />
of the <strong>Insurance</strong> <strong>Fraud</strong> Bureau back in January 2023,<br />
where your initial priority has since been around<br />
shaping, planning and publishing the IFB’s new threeyear<br />
counter-fraud strategy. Tell me more about<br />
these plans!<br />
AFundamentally, the overall strategy is all about modernising the IFB.<br />
It was established in 2006, initially to share data sets in a simple<br />
and efficient way. Many insurers have naturally evolved in this time,<br />
incorporating their own ways of identifying and managing fraud in-house. So,<br />
working in line with the industry and following extensive consultation, the IFB<br />
would like to expand its membership to make this offering more inclusive.<br />
We’d like to incorporate firms which support the industry in fraud detection,<br />
and invite other parts of the industry to come on board as well who may<br />
have previously been exempt. We are currently looking at the art of the<br />
possible in this respect.<br />
In terms of our existing network, we want to focus on giving our members<br />
what they want, as opposed to a continuation of what they’ve always had.<br />
We’d like to decommission some of our legacy technology as part of this<br />
process; we’ve got different technology for different things, and we want to<br />
simplify this and make sure that it works better for our members, with selfserve<br />
capabilities and higher quality data output.<br />
Our final strand of the strategy lies around prevention. <strong>The</strong> industry have<br />
wanted to implement an effective prevention campaign for a really long time,<br />
educating the UK public around what insurance fraud is and the subsequent<br />
ways to avoid falling victim to this type of criminal activity. <strong>The</strong> IFB have<br />
recently targeted the general public in a number of campaigns, an example of<br />
which is around the concept of moped fraud, complete with airtime on the<br />
national news. We’ve had 25 further Cheatline reports made directly to us on<br />
the back of this - with insurers reporting an increase in new reports, too - as<br />
policyholders retrospectively realise that they have fallen victim to this type<br />
of fraud in the past.<br />
QOpportunistic fraud appears to be increasing more<br />
than many other aspects of the fraud landscape. On<br />
the subject of awareness campaigns, how are you<br />
educating the public about the potential long-term<br />
impacts?<br />
AOver the last quarter, we’ve been running a number of different<br />
campaigns based around a variety of insurance products. <strong>The</strong><br />
fundamental message is one of education, teaching the UK public all<br />
about insurance fraud, what it is, and how it differs from a genuine claim. In<br />
light of the present cost-of-living crisis, customers may be more tempted or<br />
under pressure to commit fraud in an opportunistic way.<br />
However, if we can focus some of our energy on awareness and prevention<br />
campaigns, we can really demonstrate the implications of fraudulent activity<br />
and reiterate the fact that insurance fraud is not a victimless crime. If a<br />
member of the public is found to have committed insurance fraud, and if the<br />
evidence is there to support it, they will be placed on the <strong>Insurance</strong> <strong>Fraud</strong><br />
Register. Many people don’t know this, nor are they aware of the role that<br />
IFED play in the criminal justice aspect. <strong>The</strong> <strong>Insurance</strong> <strong>Fraud</strong> Register can<br />
prevent someone from accessing insurance policies in future, and we are<br />
really hoping to get the message out there and encourage people to think<br />
twice about these consequences before they submit a false claim.<br />
4 <strong>Fraud</strong> <strong>Supplement</strong>
with Ursula Jallow<br />
QAs cyber threats increase, we know that outdated<br />
legacy technology can affect the success of counterfraud<br />
strategies. Since decommissioning your own<br />
legacy technology is a priority over at the IFB, how<br />
are you seeking to educate, encourage and influence<br />
positive change for your members in this regard?<br />
AFrom our perspective, insurers are ultimately the ones that will make<br />
their own decisions on their legacy technology. For many insurers,<br />
this is certainly a priority for them too, and they are following suit in<br />
order to make positive changes to their infrastructure.<br />
New IFB platforms will go some way to help insurers more broadly, but we<br />
do recognise that it’s not a case of ‘one size fits all’. With these platforms, we<br />
hope to provide new product solutions and positively improve the quality of<br />
our data.<br />
Not all insurers will have the data you’d expect them to have, so it’s also about<br />
the enrichment of that, as well as creating support provisions for members<br />
who want to implement this kind of strategy. It’s a complex piece of work;<br />
every insurer is different, and we also have the broker market to consider as<br />
well. We can help, but internal decisions will always lie with the organisations<br />
themselves.<br />
QSo, what more needs to be done to address this issue<br />
around improving access to data, and the quality of<br />
that data? How can we tackle the perception that<br />
sharing data is a competitive risk?<br />
A<strong>The</strong> majority of the industry are very good at detecting fraud,<br />
particularly in comparison to where the market was 25 years ago!<br />
Organisations are now advising their policyholders about fraudulent<br />
activity in order to prevent them from becoming victims, and we have<br />
specialist areas of the industry that remain responsible for addressing and<br />
tackling fraudulent behaviour. Massive strides have been taken on the Motor<br />
and Personal Lines side of the industry, and I’m confident that they are doing a<br />
really great job even at pricing and underwriting stage.<br />
However, each insurer will face their own challenges across a diverse book<br />
of business and a variety of product lines. At the IFB, we’re happy to help our<br />
members with their fraud prevention and detection strategies, supporting<br />
them in making their processes and controls more robust. It’s important to<br />
acknowledge that the industry has moved beyond their focus on claims in<br />
the fraud prevention space, opening the conversation to address policy and<br />
underwriting as well. In theory, if we’re getting it right in those foundational<br />
stages, we won’t see fraudulent claims come through on the other end.<br />
It’s also important to question the digital side of things when we’re considering<br />
an insurer’s customer journey. Some insurers are not there yet with their<br />
digital processes, whereas others are heavily digitalised and need to consider<br />
how fraud relates to that platform, as well as how they’re sourcing their<br />
policies and claims.<br />
In relation to concerns around competitive risk, the Financial Conduct<br />
Authority (FCA) expects insurers to have appropriate systems and controls<br />
in place, and part of that relates to the sharing of data. From a regulatory<br />
perspective, compliance with this aspect is pivotal. Moreover, from an<br />
insurer perspective, if you’re sharing data in the way that you should be, this<br />
intelligence will work to the benefit of the consumer. Consumers rightfully<br />
expect us to do the right thing and band together to protect them against<br />
the risk of fraud. With this in mind, industry compliance with data sharing is<br />
imperative for us to tackle insurance fraud as a collective market.<br />
QYou work very closely with law enforcement as well<br />
as those within the insurance ecosystem. How has<br />
successful cross-sector collaboration influenced the<br />
work you do at the <strong>Insurance</strong> <strong>Fraud</strong> Bureau, and<br />
where might improvements still be made?<br />
AYes! Working closely with IFED, we supply additional evidence to<br />
aid investigations when needed, and we also make referrals to IFED<br />
on behalf of insurers. We haven’t always been as joined up as we<br />
could be in terms of our communications, but we’ve really harnessed our<br />
partnership in recent awareness campaigns and continue to dedicate time to<br />
the promotion of each other’s work. <strong>The</strong>re’s always scope to become more<br />
efficient together, and we’re committed to continuously improve our working<br />
relationship wherever opportunities are identified.<br />
QFinally, is it possible to predict ‘trends’ in the fraud<br />
landscape, so those across the industry might begin<br />
to adopt a proactive, rather than reactive, approach?<br />
What key elements of progress should the industry be<br />
looking out for over the next few years?<br />
APredictions can be really difficult to make! However, I do believe<br />
that our reliance on digital platforms will only increase. For example,<br />
if we look back at the growth and prevalence of social media over<br />
the last decade, we can get a decent idea of what we’re going to have to keep<br />
up with as an industry. I’m sure the focus around servicing the consumer on<br />
their terms will continue, and with this comes a need for fraud detection<br />
tools which are as up-to-date as possible.<br />
Our latest industry threat assessment reveals that Artificial Intelligence is a<br />
concern, with ChatGPT already presenting some tough challenges. That being<br />
said, these tools all form a part of how we’re using digital platforms to live<br />
our lives in the modern age, and we will need to keep our finger on the pulse<br />
to monitor the effects of AI and Machine Learning going forward.<br />
Ursula Jallow,<br />
Director of the <strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB)<br />
<strong>Fraud</strong> <strong>Supplement</strong> 5
‘Collaboration at its Finest’<br />
with DCI Tom Hill<br />
QDetective Chief Inspector Hill,<br />
thank you so much for joining me<br />
today! Let’s start by talking about<br />
the work you do over at the <strong>Insurance</strong><br />
<strong>Fraud</strong> Enforcement Department within<br />
City of London Police. What are your key<br />
objectives?<br />
AThanks Amelia, great to meet you!<br />
Our key objective in the first<br />
instance is to tackle insurance<br />
fraud and provide a deterrent for criminals<br />
operating in this area. <strong>The</strong> department<br />
succeeds by alleviating some of the<br />
pressure on regional law enforcement,<br />
particularly those who don’t have the<br />
capacity to adequately tackle this type of<br />
crime themselves.<br />
For the foreseeable future, our objectives<br />
are aimed at three key pillars. Enforcement<br />
is our primary focus; we must continue<br />
to provide an effective response for<br />
insurance fraud victims, performing our role<br />
professionally and independently. This will<br />
take the form of positive judicial outcomes,<br />
alternative outcomes, and diversionary<br />
tactics.<br />
Disruption is also a key area, relating to<br />
the mapping and interference of organised<br />
crime groups as well as lower level,<br />
opportunistic fraudsters. We use a relatively<br />
new tactic in the form of cease and desist,<br />
which is a strong way of diverting insurance<br />
fraud criminals away from the criminal<br />
justice system and closely monitoring<br />
their offending. ‘Operation Mirage’ is our<br />
dedicated arm of the team responsible<br />
for tackling the online landscape, working<br />
closely and successfully with social media<br />
companies in order to take down profiles<br />
which represent a threat.<br />
Our third key objective lies around<br />
protection and prevention. Publicising our<br />
work and promoting awareness of what we<br />
do is vital. We’re delighted to have recently<br />
secured funding to continue our work past<br />
December when our initial agreement with<br />
the ABI comes to end. This will allow us to<br />
work on keeping our reoffender rates low,<br />
and remain at the forefront of the fight<br />
against fraud within the insurance industry.<br />
QOn the subject of awareness, a<br />
national campaign was launched<br />
earlier this year to highlight the<br />
consequences of opportunistic fraud,<br />
with motor fraud seeing the biggest<br />
increase. It’s obviously still very early<br />
days, but how has the campaign been<br />
received so far?<br />
AWe chose to look at opportunistic<br />
fraud through consultation with the<br />
industry, after seeing a 60% increase<br />
predominantly in light of the cost-of-living<br />
crisis. <strong>The</strong> campaign was a great way to<br />
get some national coverage; it did really<br />
well on social media and within our partner<br />
networks, too.<br />
Sadly, I don’t think this is an issue that<br />
will be going away anytime soon, but<br />
I’m confident that the messaging of our<br />
campaign is strong and long-lasting. We’ve<br />
certainly seen a spike in operational activity<br />
as a consequence of this work, particularly<br />
as we raise our profile and create further<br />
awareness of our key objectives with the<br />
general public.<br />
QEvidence shows that much<br />
fraudulent activity relates to<br />
organised crime. Why does<br />
insurance fraud remain such a prevalent<br />
target for these crime networks? And as<br />
we move towards a cashless society, is<br />
cash still a priority for the crime networks<br />
that continue to operate within financial<br />
services?<br />
AAlthough we do target organised<br />
crime groups, opportunistic fraud<br />
is certainly most prevalent in<br />
insurance compared with other types of<br />
fraud. However, we do deal with the full<br />
spectrum at IFED, and sadly, organised<br />
crime groups will always operate through<br />
exploiting the weaknesses, processes and<br />
systems in place across the insurance<br />
sector.<br />
We respond by mapping the activity<br />
of these organised crime groups and<br />
recording disruptions against them, which<br />
enables us to access additional tactics<br />
and resources within the law enforcement<br />
network - particularly those which might<br />
not be in place to the same extent for other<br />
types of fraudulent activity.<br />
In relation to cash, we’re certainly still<br />
seeing cases where cash is seized from<br />
fraudsters before it has been converted<br />
to money laundering. We actually had a<br />
successful cash seizure earlier this year,<br />
with over £100,000 seized from a ghost<br />
broker. So, yes – we do still see cash<br />
being used as a way to launder funds,<br />
and we frequently embrace the skills of<br />
our financial investigators to monitor the<br />
movement of said funds. It’s a resource<br />
that we’re delighted to have - facilitating<br />
confiscation and, most importantly,<br />
providing compensation for insurer victims.<br />
QDo you feel that existing<br />
legislation is fit for purpose when<br />
it comes to prosecuting fraud as<br />
it evolves and takes on different<br />
shapes?<br />
AIn short, yes, existing legislation is<br />
absolutely fit for purpose when it<br />
comes to tackling fraud. <strong>The</strong> <strong>Fraud</strong><br />
Act and the Financial Services and Markets<br />
Act are both powerful pieces of legislation;<br />
we also prosecute under money laundering<br />
legislation to gain positive outcomes for<br />
victims of fraud. In terms of what we’ve<br />
got coming down the tracks, I’m eagerly<br />
anticipating the Online Safety Bill, a law<br />
6 <strong>Fraud</strong> <strong>Supplement</strong>
Tackling insurance fraud often requires both<br />
public and private sectors to work in harmony<br />
together. <strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> recently<br />
caught up with DCI Tom Hill, Head of the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Enforcement Department (IFED)<br />
at the City of London Police, to discuss the impact<br />
of recent awareness campaigns, the efficacy of<br />
existing legislation, and the significance of the<br />
industry’s collaborative efforts in the<br />
ever-present fight against fraud.<br />
which will add to our protection efforts<br />
against fraudulent activity across social<br />
media platforms and online search engines.<br />
However, there is extreme pressure on the<br />
criminal justice system at the moment,<br />
and a successful prosecution now requires<br />
our case to be fully ready for trial, even<br />
if the defendant has submitted an early<br />
admission to the offence. This means that<br />
there’s a lot of extra emphasis on getting<br />
the disclosure right, and working with the<br />
Crown Prosecution Service to progress and<br />
prosecute each case accordingly. We need<br />
to use innovative tactics in order to take<br />
pressure off the criminal justice system<br />
wherever possible, and find alternative<br />
outcomes beyond that of a prison sentence.<br />
If a case needs to be prosecuted, of<br />
course we will prosecute that case. But it’s<br />
important for us to deal with cases outside<br />
of the parameters of the criminal justice<br />
system at the moment if it is possible for<br />
us to do so.<br />
QHow are victims of insurance<br />
fraud being supported in the face<br />
of rising fraud cases, particularly<br />
those with vulnerability<br />
characteristics?<br />
AI don’t know anyone in the industry<br />
who doesn’t want to do more to<br />
protect and support victims of<br />
fraud. Empowering the public complements<br />
the Government’s fraud strategy, but better<br />
support and communication with fraud<br />
victims is also a huge priority for the team<br />
at IFED. We are part of a working group at<br />
the General <strong>Insurance</strong> <strong>Fraud</strong> Committee<br />
(GIFC), which looks into how we can better<br />
support victims of insurance fraud and<br />
ensure that the provisions currently in place<br />
are fit for purpose - all with a view to create<br />
more effective wraparound support across<br />
the full industry ecosystem.<br />
This fits in well with our National Economic<br />
Crime Victim Care Unit (NECVCU), which<br />
has now been rolled out across all police<br />
forces in England and Wales. While this<br />
focuses on fraud and cybercrime, perhaps<br />
the NECVCU hasn’t had much opportunity<br />
to focus on insurance fraud yet because in<br />
this instance, victims are often insurers –<br />
as opposed to vulnerable members of the<br />
public who have had their identity stolen,<br />
for example. A logical next step would be<br />
about understanding how we could better<br />
work with these teams to provide more<br />
assistance in the face of insurance fraud<br />
cases, particularly for those most at risk.<br />
QIn relation to insurance fraud,<br />
what improvements would<br />
you like to see with regards to<br />
collaboration and data sharing between<br />
the public and private sectors? What<br />
existing strategies are already in place<br />
and proving the most effective?<br />
A<strong>The</strong> whole concept of IFED as<br />
it exists now demonstrates<br />
collaboration at its finest. We’re<br />
frequently in attendance at in-person and<br />
remote industry events, giving talks about<br />
the work we’re up to in the fraud arena and<br />
talking to industry professionals about the<br />
support available. City of London Police<br />
are really leading the way in this area; the<br />
collaboration in place between IFED and<br />
industry is envied across Europe and around<br />
the world. Our close working partnership<br />
with the <strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB)<br />
also drives this success, particularly when<br />
we’re serving cease and desist notices and<br />
carrying out further surveillance to ensure<br />
that fraudulent activity stops as a result.<br />
<strong>The</strong> data sharing principles currently in<br />
place allow us to escalate our response if<br />
cease and desist notices are being ignored.<br />
It’s a relationship that has stood the test<br />
of time, and one that will continue to bring<br />
longevity to the success of our operations.<br />
I also work with the London <strong>Fraud</strong> Forum,<br />
which is a public/private partnership to<br />
combat fraud across all sectors. <strong>The</strong>re’s<br />
the law enforcement side of the board<br />
which I represent, juxtaposed with the<br />
private sector influence as well. It creates<br />
a fantastic dynamic and presents ample<br />
opportunity to understand the wider<br />
threat and share our core knowledge.<br />
Collaboration is key in the fight against<br />
fraud; we’re more likely to be victims of<br />
fraud than any other type of crime, and<br />
the only way to tackle that is through<br />
partnerships of this kind.<br />
QLastly, what are your predictions<br />
for the remainder of this year<br />
with regards to the insurance<br />
fraud landscape?<br />
AI think we’re going to see a<br />
significant investment in cyber<br />
skills. 89% of fraudulent cases are<br />
cyber enabled, so building that expertise<br />
and working with the private sector to<br />
enhance fraud detection and prevention<br />
is key. <strong>The</strong> technology that has been<br />
developed to tackle fraud in the insurance<br />
industry is fascinating, and for IFED to<br />
harness this knowledge and understand<br />
more of that will be vital for us. Within IFED,<br />
we’ll probably allocate more resources to<br />
that area in the very near future in order to<br />
address a growing demand in this space.<br />
Finally, I expect IFED to partner with<br />
insurers and look further into the<br />
disruption of commercial insurance fraud<br />
over the coming months - commercial<br />
being an area of fraud which hasn’t<br />
traditionally been addressed so much by<br />
law enforcement. We’ll also be keeping<br />
our finger on the pulse when it comes to<br />
inflation and cost-of-living issues, factors<br />
that will continue to influence the likelihood<br />
of fraudulent activity.<br />
DCI Tom Hill,<br />
Head of the <strong>Insurance</strong> <strong>Fraud</strong> Enforcement<br />
Department (IFED) at City of London Police<br />
<strong>Fraud</strong> <strong>Supplement</strong> 7
with Lior Koskas, Digilog<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> catches up with Lior Koskas,<br />
CEO at Digilog, to discuss the benefits of their innovative<br />
technology, the accredited training courses on offer, and<br />
their recent <strong>Fraud</strong> Supper Club at Home Grown, London.<br />
8 <strong>Fraud</strong> <strong>Supplement</strong>
Hello Lior, always great to catch up!<br />
Q Let’s start by talking about Digilog and the amazing work<br />
you guys do in the fight against fraud. How do these efforts<br />
apply to the insurance industry specifically?<br />
Digilog offers the latest generation of technology solutions,<br />
utilising voice risk analysis for risk identification and information<br />
A validation. Combined with AI and cognitive interviewing techniques,<br />
our technology represents an innovative and promising approach<br />
to enhancing fraud detection and risk management throughout the<br />
insurance industry.<br />
Our Digital intelligence Voice Analysis (DiVA) software is designed to<br />
complement existing processes. It integrates seamlessly with insurers’<br />
current systems and workflows, reducing disruption and enhancing the<br />
adoption of technology. Of course, this is crucial in the insurance industry<br />
especially, where thousands of interactions occur daily. <strong>The</strong> primary focus<br />
is twofold – we concentrate on risk identification, as well as contributing<br />
to a better customer experience by expediting legitimate claims and<br />
reducing the need for lengthy investigations.<br />
<strong>The</strong> ability to deploy our technology across areas where real-time<br />
conversation/information validation is required also makes it extremely<br />
versatile. <strong>The</strong> live environment for identifying and challenging risks can<br />
be a game-changer, and using voice data in real-time can provide<br />
valuable insights into the authenticity of claims or applications. This can<br />
help identify potential fraud or misrepresentation as soon as it occurs.<br />
Early detection of potential fraud can also prevent payouts on illegitimate<br />
claims, and reduce overall losses for insurance companies.<br />
Q<br />
A<br />
Your Digital intelligence Voice Analysis (DiVA) software<br />
utilises voice data to identify and combat fraudulent activity.<br />
Tell me more about that!<br />
High-level: DiVA, drawing upon sophisticated algorithms,<br />
incorporates ML capabilities to automatically calibrate and<br />
establish a baseline of the subject’s voice pattern. DiVA will then<br />
analyse potential fraud risk in real-time transactions, based on open and<br />
unrestricted conversations, to detect patterns and anomalies that may<br />
indicate fraudulent behaviour.<br />
<strong>The</strong> subject’s voice is represented as a digital waveform pattern.<br />
Initially, the ‘calibration’ phase will obtain digital raw data from the<br />
voice spectrum (broken down into two second segments) to create an<br />
individual’s unique ‘truthful’ baseline from known facts, like personal<br />
details. DiVA will then analyse and compare further segments to the<br />
baseline throughout the exchange.<br />
In doing so, DiVA’s risk-identification algorithms will automatically identify<br />
honest and potentially dishonest statements in real-time - enabling the<br />
fast-track of genuine customers, as well as pinpointing any relevant risk<br />
issues that require further validation or investigation.<br />
Q<br />
A<br />
What benefits does software such as DiVA present for<br />
businesses and organisations within the insurance<br />
ecosystem?<br />
To understand the benefits, we first need to recognise motivating<br />
factors in relation to insurance fraud. Economic fluctuations and<br />
the current ever-rising cost of living can impact insurance fraud<br />
rates. Individuals may be more inclined to commit fraud during times of<br />
economic hardship in order to obtain financial gains. Unfortunately, many<br />
people regard insurance claims as a soft and easy target. Equally, when<br />
the economy is stable and prosperous, the motivation for fraud often<br />
decreases.<br />
That being said, as technology advances, both fraudsters and insurance<br />
companies adapt their methods. New technologies enable more<br />
sophisticated fraudulent schemes, yet on the flipside, developments<br />
in technology can also provide insurers with improved fraud detection<br />
and prevention tools. As a result, there is a continuous battle between<br />
fraudsters and insurance companies, with the aim of outsmarting one<br />
another in a bid to shape the fraud landscape.<br />
Ultimately, we want to assist insurance companies by providing<br />
enhanced fraud identification and prevention capabilities, whilst fostering<br />
innovation. This is where DiVA comes into play, providing voice risk<br />
analysis output in conjunction with behavioural narrative-integrity<br />
indicators to validate truthful and potentially deceptive statements. Such<br />
a solution enhances the validity of customer-agent interactions, bringing<br />
technology and human capabilities to the forefront in the fight against<br />
fraud. This combination leverages the strengths of both to create a more<br />
robust anti-fraud approach.<br />
Digilog are also accredited to host <strong>Fraud</strong> Awareness<br />
Training Courses to the wider insurance/broker industry.<br />
Q Tell me more about this, and the variety of options on offer.<br />
AAll businesses within the insurance market are faced with<br />
the pervasive threat of fraud, hence there is a necessity for<br />
organisations to invest in training their workforce in the fight<br />
against this growing risk. <strong>Fraud</strong> poses a significant challenge across<br />
the entire insurance landscape, and a failure to address it can have farreaching<br />
consequences.<br />
We aim to support organisations by providing skill-enhancement<br />
opportunities through bespoke training and the opportunity to obtain<br />
further qualifications, on top of exposure to our cutting-edge technology.<br />
Appropriate training for insurance personnel who interact with the<br />
system and seamless integration with their workflow are critical for the<br />
successful adoption of the technology.<br />
Our accredited training programmes are a great way of ensuring that<br />
fraud awareness training is standardised across an organisation. Training<br />
programmes are modular in design, with courses customised and<br />
tailored to suit client requirements. We offer courses around Introduction<br />
to <strong>Fraud</strong>, Risk Screening & Conversation Management Techniques,<br />
as well as Interviewing & <strong>Fraud</strong> Investigations Techniques, for new or<br />
existing members of staff.<br />
In recent years, we have dedicated substantial time and investment<br />
into transposing our training material into an ergonomic eLearning<br />
platform whilst streamlining modules and content (along with digitalised<br />
supporting handouts). This has enabled us to provide training support for<br />
remote workers, mitigating requirements for travel and onsite disruption<br />
by facilitating online, flexible training, nationwide and internationally, with<br />
significant cost savings.<br />
Q<br />
Earlier this year, you hosted the inaugural Digilog <strong>Fraud</strong><br />
Supper Club at Home Grown, London - the purpose of<br />
which was to discuss the evolution of fraud following<br />
continuous economic downturn in the UK market. Tell me more<br />
about the key takeaways from this event.<br />
AYes – this was a fantastic event, and something that we are<br />
certainly looking to repeat after such a productive discussion!<br />
We invited attendees from varying insurance and fraud-related<br />
backgrounds. It was the perfect venue and a relaxed setting in which to<br />
invite debate - we thank those that were in attendance for their valuable<br />
contributions and insight, which led to number of engaging discussions,<br />
with a particular focus on the cost-of-living crisis and its subsequent<br />
impact upon insurance fraud, as well as the use of technology to<br />
mitigate negative outcomes.<br />
Indeed, the cost-of-living crisis has far-reaching impacts on individuals<br />
and society as a whole. It can contribute to various economic and social<br />
challenges, and financial pressure is a significant driver that can lead<br />
some individuals to consider fraudulent activities as a means to alleviate<br />
their financial burdens. This includes insurance fraud, which can take<br />
various forms such as fraudulent claims, providing false information on<br />
insurance applications, or staged accidents.<br />
It is crucial for insurers, MGAs and brokers to prioritise the quality of<br />
insurance arrangements and actively work to identify, combat and<br />
eradicate fraudulent claims. <strong>Fraud</strong>ulent activities can manifest not<br />
only during the claims process, but also at the inception of a policy.<br />
Our discussions merely reiterated the need for a comprehensive and<br />
cautious approach when reviewing insurance applications, with key<br />
considerations such as data analytics, Know Your Customer (KYC),<br />
industry collaboration, training and awareness, as well as technological<br />
solutions.<br />
Lior Koskas,<br />
CEO, Digilog UK<br />
<strong>Fraud</strong> <strong>Supplement</strong> 9
Helping businesses<br />
make better<br />
decisions.<br />
Machine Learning<br />
Artificial Intelligence<br />
to analyse & validate<br />
risk in a telephone or<br />
video conversations.<br />
Our unique software enables<br />
the fast & accurate validation<br />
of genuine customers whilst<br />
identifying key risk issues<br />
associated with a:<br />
Claim<br />
Dispute<br />
Application<br />
Find out more at<br />
digiloguk.com
Delivering a<br />
great customer<br />
experience and<br />
detecting fraud<br />
doesn’t have<br />
to be a doubleedged<br />
sword<br />
Digital automation has brought many<br />
gains to our industry, including an<br />
enhanced customer experience and<br />
increased insurer efficiency. However,<br />
these advantages have come at a<br />
cost, with a significant 61% increase in<br />
opportunistic fraudulent claims.<br />
With the cost-of-living crisis putting more pressure on households,<br />
the <strong>Insurance</strong> <strong>Fraud</strong> Enforcement Department (IFED) believes that<br />
growing numbers of otherwise honest people are inflating claims to<br />
ease financial difficulties. From opportunistic customers inflating<br />
claims, to organised criminal rings staging elaborate scams, fraud<br />
eats into insurers’ bottom lines, ultimately driving premiums up for<br />
honest policyholders.<br />
Whether you’re an insurer, a supplier, broker or third-party<br />
administrator, fraud is a growing threat that costs the industry<br />
billions each year. So, how can we prevent fraudsters from abusing<br />
new technology, without losing the benefits it brings to customers<br />
and insurers alike?<br />
Gaps and opportunities that fraudsters are<br />
exploiting today<br />
While organised fraud remains a serious issue, insurers reported a<br />
concerning 61% increase in opportunistic fraud over the past year –<br />
costing the industry £1.1bn in 2022. Motor insurance was the most<br />
common type of opportunistic fraud reported to IFED, accounting<br />
for over half of all cases.<br />
Continued on p13<br />
Insurers are also feeling the pressure of rising costs in motor<br />
claims, amounting to £2.5bn paid out in the second quarter of this<br />
year. <strong>The</strong>re’s also the added strain of new Consumer Duty regulatory<br />
requirements, not to mention paying out claims fairly and quickly<br />
to honest policyholders – all while trying to weed out fraudulent<br />
activity!<br />
<strong>The</strong> Whiplash reforms have had an initial positive impact for<br />
insurers. £602mn of the payout in motor claims was in the<br />
personal injury space, down by 8% in the same period last year.<br />
<strong>The</strong> extension of Fixed Recoverable Costs (FRC’s) to cover most<br />
personal injury claims up to £100,000 in value could also reduce<br />
legal costs for insurers and claimants, removing financial incentives<br />
for legal firms to inflate hours.<br />
<strong>Fraud</strong> <strong>Supplement</strong> 11
Continued from p11<br />
However, this could also lead to an inflation of claims values<br />
by some legal firms, with researchers seeing a rise in ‘cynical<br />
conveyor belt processes’ that entirely fabricate or exaggerate<br />
injuries. So, while government reforms may be reducing<br />
claims payouts, fraudsters are now shifting focus to exploit<br />
other areas of insurance instead.<br />
IFED also reported that property insurance fraud was<br />
the second most common type of opportunistic fraud,<br />
accounting for 29% of reports. Commercial and residential<br />
property insurance fraud are both seen as high risk for<br />
insurers today due to the amount of ‘unknowns’ compared to<br />
motor or personal injury, and the possibility of high value that<br />
it could bring to fraudsters.<br />
In one instance, a customer from south London was charged<br />
with fraud by false representation after submitting claims<br />
for the same television on two home insurance policies. In<br />
another instance, IFED officers cautioned a claimant when<br />
they detected edited invoices from a hotel to inflate the costs<br />
following water damage to their home.<br />
<strong>Fraud</strong> in the digital age – what does it look like?<br />
Insurers are deploying Anti-<strong>Fraud</strong> technology, like analytics<br />
and AI, to spot red flags and detect suspicious patterns in<br />
underwriting and claims. But fraud evolves rapidly, often<br />
finding new ways to exploit emerging technology itself.<br />
As much as a digital claims journey can improve customer<br />
experience, fraudsters are exploiting this by using chatbots<br />
to impersonate claimants, rapidly filing fraudulent claims at<br />
scale. <strong>Fraud</strong> rings leverage dark web forums to trade stolen<br />
customer data and coordinate sophisticated scams.<br />
With the rise of AI technology, the industry has also seen<br />
a rise in ‘shallow fakes’ - claims documents that are<br />
manipulated rather than fully fabricated. Some shallow<br />
fakes are altered images of alleged accidents, injuries or<br />
property damage to exaggerate losses, while others can be<br />
used to manipulate bank statements, medical records and<br />
repair invoices to make higher value claims. Deepfake videos<br />
represent the next frontier, allowing fraudsters to generate<br />
fake footage that is extremely difficult to distinguish from<br />
real events.<br />
But the increased automation of claims and new technology<br />
is certainly not going away - and neither should it, considering<br />
all the benefits it can bring to an insurer and customer.<br />
So, how do we combat this ever-evolving fraud?<br />
We must ensure that our fraud data analytics and technology<br />
remains one step ahead of the fraudsters.<br />
Verisk’s suite of Anti-<strong>Fraud</strong> solutions already provides<br />
insurers with the capacity to detect fraud at every stage of<br />
an insurance policy or claim, in every product line, in both a<br />
proactive and reactive way.<br />
Managing intelligence is a critical aspect of claim<br />
investigations, and the Verisk Intelligence solution meets this<br />
need through an entity storage system designed to capture<br />
all of the ‘known’ entities in real-time (people, companies,<br />
addresses, vehicles, phones, etc) that might relate to fraud,<br />
with a secure data depository for counter-fraud teams.<br />
Verisk’s Analytics Anti-<strong>Fraud</strong> solution takes a proactive<br />
approach, using analytics and predictive modelling to identify<br />
potential fraud as well as new and evolving trends.<br />
Verisk’s Anti-<strong>Fraud</strong> solutions are designed to be highly<br />
scalable, with a modular interface framework backed up by<br />
Verisk’s market expertise and data science teams. We fight<br />
evolving fraud whilst continuously improving the system.<br />
Digital media forensics using AI technology<br />
We’ve also invested in digital media forensics, which uses<br />
AI to identify fraud and manipulation in digital media files<br />
such as photos and documents. We’ve recently launched our<br />
Forensic Image Service in the UK across three categories:<br />
binary forensics, non-binary forensics, and advanced<br />
forensics.<br />
Binary forensics helps to detect images that have been<br />
re-used or sourced from the internet. Non-binary forensics<br />
examine the metadata of an image, such as the date, time,<br />
and location that the photo was taken. Those details can<br />
help to determine if a loss is legitimate or not. Advanced<br />
forensics uncover modifications to documents through<br />
the deep examination of structure contents, as well as the<br />
manipulation of images by analysing pixels and identifying<br />
noise patterns that the human eye can’t detect.<br />
For one insurance property adjuster, FIS detected £1mn in<br />
fraudulent claims from images submitted over a two-year<br />
period, meaning that these claims had a 16% increase in<br />
costs. For another insurer, 9% of 81,000 images analysed<br />
through Forensic Image Service were duplicates, and over<br />
700 unique claims out of 4,000 analysed were found to be<br />
suspected (or actual) fraud.<br />
<strong>The</strong> ultimate benefit of forensic technology is not just for<br />
detecting fraud, but also for processing legitimate claims<br />
faster. Insurers can be confident in paying meritorious claims<br />
quickly, which boosts customer satisfaction, shortens cycle<br />
times, and reduces costs.<br />
<strong>The</strong> fight against fraudsters persists –<br />
and evolves<br />
<strong>Insurance</strong> fraud will continue evolving as new risks and<br />
technologies emerge. From opportunistic fraudsters to highly<br />
organised criminal groups, the motivation to defraud insurers<br />
will persist.<br />
Insurers are taking the fight to the fraudsters through<br />
collaboration, as well as by harnessing data and analytics,<br />
optimising detection workflows and raising public<br />
awareness. <strong>Fraud</strong> is not a victimless crime,<br />
costing customers thousands of pounds<br />
in fines or jail time. As such, Verisk<br />
will continue to invest in emerging<br />
Anti-<strong>Fraud</strong> technologies to fight<br />
this battle.<br />
Get in touch with the Verisk<br />
team at neil.garratt@verisk.<br />
com to find out more about<br />
how our Anti-<strong>Fraud</strong><br />
solutions can help<br />
your business.<br />
<strong>Fraud</strong> <strong>Supplement</strong> 13
CATCHING UP<br />
with Donna Scully, Carpenters Group<br />
Carpenters Group are setting a gold standard for industry collaboration in the fight<br />
against insurance fraud. We recently caught up with Donna Scully to further discuss<br />
her role in this process, the education of Carpenters Group case handlers, and the<br />
significance of their affiliate membership to the <strong>Insurance</strong> <strong>Fraud</strong> Bureau.<br />
QHi Donna, thanks so much for your time<br />
today!<br />
<strong>The</strong> <strong>Fraud</strong> Unit at Carpenters Group works<br />
closely with their insurer clients to identify (and<br />
strategise against) the rising threat of fraud.<br />
Where have your key priorities sat lately in<br />
terms of fraud and fraudulent activity?<br />
A<strong>The</strong> current economic climate and cost of<br />
living crisis have undoubtedly fuelled an<br />
increase in opportunistic fraud. Exaggerated<br />
and contrived claims are a threat across all heads of<br />
loss, including injury, credit hire and vehicle related<br />
damages. Carpenters Group work closely and<br />
collaboratively with our insurer clients to identify<br />
and challenge organised and opportunistic fraud<br />
alike.<br />
We warn clients about the adverse impact of<br />
fraud - both around those committing it and also<br />
innocent premium paying motorists who end up<br />
paying more because of it.<br />
QAwareness is key! How does fraud factor<br />
into the education and training of your<br />
in-house case handlers?<br />
AOur case handlers are passionate about<br />
fighting fraud. <strong>The</strong>y are our first line of<br />
defence, and training our case handlers on<br />
how to spot the signs of fraud is a key part<br />
of our training programme.<br />
We have developed our own claims development<br />
programme for our in-house claims team, and fraud<br />
plays a central role. As affiliate members of the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB), and working closely<br />
and collaboratively with our insurer partners, we<br />
are also able to provide our case handlers with<br />
insights around the latest trends and risks.<br />
QWith increased digital transformation<br />
comes an increased risk of vulnerabilities<br />
and exposure to possible fraudulent<br />
activity. However, technology can also work<br />
in our favour when it comes to identifying<br />
suspicious fraud triggers.<br />
How are you embracing technology in relation<br />
to the fight against fraud, and how are<br />
you continuing to balance this with human<br />
sensibility?<br />
A<br />
“Having the right people with the right skills,<br />
using the right technology” is a Carpenters<br />
Group philosophy. <strong>The</strong> right technology<br />
is an enabler, and must be supported with the<br />
appropriately trained, experienced and passionate<br />
people when it comes to the fight against fraud.<br />
Our counter fraud teams and case handlers are<br />
skilled in using technology to detect and prevent<br />
fraud. This includes analysing data washed against<br />
industry databases, utilising telematics data<br />
throughout the claims journey, and harnessing<br />
technology to identify ‘deep fakes’.<br />
QYou are the Chair of the <strong>Insurance</strong> Times<br />
<strong>Fraud</strong> Charter, which has been running<br />
for over 10 years now. What does this<br />
role entail, and where does your focus lie<br />
at the moment?<br />
A<br />
My<br />
involvement with the <strong>Fraud</strong> Charter goes<br />
back over 10 years. As then Chair of the<br />
Motor Accident Solicitors Society (MASS),<br />
my manifesto was to try and link the<br />
industry up more by fighting fraud<br />
collaboratively.<br />
At my first Conference, I invited renowned antifraud<br />
champion, the late Richard Davies from AXA,<br />
to talk about my plans. As you’d imagine, he was<br />
excellent, and he agreed with my agenda that<br />
we have to leave competition at the door when<br />
14 <strong>Fraud</strong> <strong>Supplement</strong>
Donna Scully, Director,<br />
Carpenters Group<br />
it came to fighting fraud. We both thought of the<br />
greater good, especially around protecting innocent<br />
policyholders.<br />
By way of reciprocation, Richard invited me to the<br />
new <strong>Insurance</strong> Times <strong>Fraud</strong> Charter, sponsored by<br />
AXA. I was there as the Chair of MASS and as a<br />
claimant lawyer, so suffice to say, there was no red<br />
carpet put out for me! That did not deter Richard,<br />
and like me, he felt you had to have everybody<br />
round the table to have a true debate and break<br />
down barriers.<br />
When he got ill and AXA were no longer sponsoring<br />
the Charter, I took over the position of Chair, as<br />
well as the sponsorship side of things. I often<br />
hope that Richard is impressed with what we have<br />
achieved. We have many very important anti-fraud<br />
experts in attendance, talking openly and working<br />
collaboratively to share data, information, and to<br />
fight fraud in a joined-up way. We wish he was still<br />
here, and he will always be missed by us all.<br />
Chairing, sponsoring and being a part of the <strong>Fraud</strong><br />
Charter is great for Carpenters Group in terms of<br />
being an active part in the fight against fraud. Our<br />
Head of Defence and our Director of Claims Strategy<br />
both attend, too.<br />
QCarpenters Group is an affiliate member<br />
of the <strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB).<br />
How does this membership encourage<br />
and nurture industry collaboration in the fight<br />
against fraud? What does this partnership look<br />
like in practice?<br />
AGetting affiliate membership of the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Bureau took a while. We<br />
had to go through in-depth due diligence to<br />
show that fighting fraud was at the centre of all we<br />
do, as well as demonstrating that our technology<br />
and data protection methods are robust.<br />
Our affiliate membership encourages fraud<br />
prevention through sharing knowledge, as well as<br />
the latest intelligence, between members, all of<br />
whom work collaboratively towards our shared goal<br />
of detecting and preventing fraud.<br />
Our counter fraud teams meet regularly with the<br />
IFB and their members to discuss cases, emerging<br />
threats and trends, share intelligence and develop<br />
counter fraud strategies.<br />
Q<strong>Insurance</strong> fraud is a dynamic beast. With<br />
your finger on the pulse, how do you<br />
foresee the future of fraud evolving in<br />
the coming years?<br />
A<strong>The</strong> IFB are the industry lead on coordinating<br />
all matters in relation to fraud. We receive<br />
daily uploads of key attractors, IFB reports,<br />
Application <strong>Fraud</strong>, Cheatline Intelligence and more<br />
in a generic data feed, which merges directly into<br />
our claims system, Hotspot reports, Miscellaneous<br />
Intelligence, Operation Intelligence, network<br />
reports and SRA data.<br />
In terms of evolving technology, one would expect<br />
to see an earlier identification of fraud through<br />
mechanisms such as voice recognition, especially<br />
at FNOL. Machine Learning will also play a part<br />
though data collection, particularly as we see more<br />
vehicles carrying telematics data.<br />
<strong>The</strong> key areas of investigation at present involve<br />
Claimant Solicitors acting without instruction, cost<br />
layering, exaggeration, and medical exaggeration.<br />
We are paying particular attention to induced,<br />
contrived and staged collisions occurring in North/<br />
North West London involving motorcycles ridden<br />
by couriers, and liaising with the wider industry<br />
on these matters via the IFB’s platform. We are<br />
also actively reviewing layering of injuries and<br />
rehabilitation, with tactics specifically targeting this<br />
area for such claims as tinnitus.<br />
Notwithstanding technology advancements,<br />
collaboration really is the key to successfully<br />
fighting fraud – and Carpenters Group are at the<br />
very forefront of that.<br />
<strong>Fraud</strong> <strong>Supplement</strong> 15
MEMBER<br />
Fearless fraud prevention, in collaboration with you<br />
Find out more:<br />
www.carpentersgroup.co.uk
ENHANCING<br />
SPECIAL<br />
INVESTIGATIONS:<br />
<strong>The</strong> Role of <strong>Modern</strong> Case Management in <strong>Insurance</strong><br />
FRISS work with<br />
P&C insurers to<br />
provide the most<br />
implemented<br />
solution for trust<br />
automation across<br />
the full policy<br />
lifecycle. Martyn<br />
Griffiths, Sales<br />
Manager UKI,<br />
reports on the role<br />
of modern case<br />
management in the<br />
insurance industry,<br />
looking at the<br />
capabilities that all<br />
insurers should be<br />
looking out for in<br />
a successful fraud<br />
case management<br />
solution.<br />
Over the last 20 years, the insurance<br />
industry has taken a more focused<br />
approach to countering the fraud that<br />
impacts their bottom line - embracing<br />
new organisational structures, processes,<br />
technologies and sources of data that<br />
can help to prevent and detect fraud.<br />
More recently, the pace of technological<br />
progress means that insurers have been<br />
investing heavily in new technology<br />
to suit this very purpose. In turn, an<br />
increase in detection capabilities places<br />
an increased demand on the Special<br />
Investigations Unit. We have seen SIUs<br />
achieve over 45% gain in productivity,<br />
alongside the ability to handle three<br />
times the case volume with the same<br />
number of staff. Attending the recent<br />
Altus Consulting launch of their<br />
whitepaper ‘Service Disruption: Next<br />
Stop for Claims’, I was particularly struck<br />
by three well-made points:<br />
1. <strong>The</strong> customer has to be at the<br />
heart of your decision making and<br />
processes, with the new Consumer<br />
Duty rules focusing on good, rather<br />
than just fair, outcomes.<br />
2. <strong>The</strong> claims department is in a<br />
perennial state of transformation.<br />
3. Don’t just focus on the ‘how,’ focus on<br />
the ‘why’ and the ‘what’.<br />
Let’s examine the case for modern Case<br />
Management Software through this lens.<br />
<strong>The</strong> ‘why’<br />
1. Investments in counter fraud<br />
technology detection demand a<br />
return. As you detect more fraud,<br />
there are more cases for the SIU to<br />
review and investigate. Ultimately,<br />
the return on investment for your<br />
improved detection solutions will<br />
only be realised when fraud is proven,<br />
or when the claimant/policyholder<br />
walks away. It follows that increased<br />
detection volumes means a need for<br />
more capacity.<br />
2. <strong>The</strong> customer is still your customer,<br />
even if fraudulent activity if<br />
suspected. Not all referrals result in<br />
an investigation and proven fraud. If<br />
it is a false positive, you need a slick<br />
process to get the claim or policy<br />
back on track as soon as possible.<br />
A customer whose journey is<br />
interrupted is a potential complaint<br />
(or even a loss of that customer)<br />
waiting to happen.<br />
3. Feedback is truly a gift - although<br />
sometimes we don’t like what<br />
we hear! In the fraud detection<br />
world, feedback is also an absolute<br />
necessity. Without feedback, our<br />
fraud models and algorithms will<br />
stagnate and become less effective<br />
over time. Gathering effective,<br />
robust and granular feedback on<br />
all referrals and their outcomes is<br />
key to that improvement. If that<br />
data is not readily to hand - or even<br />
better, automated - the road to<br />
improvement will be long and windy.<br />
4. <strong>Fraud</strong> investigators have a specialist<br />
skill set. <strong>The</strong>ir valuable time needs<br />
to be spent wisely and in the most<br />
productive way possible, not on<br />
laborious and repetitive tasks.<br />
5. Monitoring both workload and<br />
outcomes can be a time-consuming<br />
affair for managers and directors,<br />
especially when they have to dip<br />
in and out of disparate platforms<br />
and spend time pulling together<br />
management reports. That time<br />
could also be spent more wisely.<br />
<strong>Fraud</strong> <strong>Supplement</strong> 17
What capabilities<br />
should an insurer<br />
look for in a modern<br />
insurance fraud case<br />
management solution?<br />
1. Integration is a key component<br />
to the successful deployment of<br />
modern insurance fraud software.<br />
Whilst you can experience gains<br />
with a standalone system, true<br />
efficiency comes from integrating a<br />
modern case management system<br />
with your claims or policy admin<br />
system. This ensures the transfer<br />
of data both to and from the case<br />
management solution, reducing<br />
the need for rekeying as well as the<br />
margin for error which can arise as a<br />
consequence.<br />
2. Once data is smoothly transferred,<br />
a modern case management<br />
solution can help you to effectively<br />
manage triage, presenting all of the<br />
information about the claim or policy<br />
to the investigator alongside reasons<br />
for the referral.<br />
By incorporating third party data<br />
connections, the investigator can<br />
gather supplemental information to<br />
more effectively inform next stages,<br />
including the decision to investigate<br />
further or determine whether this<br />
was a false positive. <strong>The</strong> next action<br />
can then be selected accordingly,<br />
such as the decision to proceed or<br />
return the case to the underwriter /<br />
adjuster, looking after the customer<br />
all the while to make sure that they<br />
are not inconvenienced.<br />
Efficiency is one way to improve<br />
triage, but in addition, you need<br />
to be able to measure productivity<br />
and performance against SLAs.<br />
Transparent dashboards that allow<br />
all interested parties to see the status<br />
of each case - and to intervene when<br />
cases fall outside of SLA’s, reallocating<br />
workloads where necessary - means<br />
that nothing will be allowed to sit<br />
and stagnate.<br />
3. When it comes to insurance fraud<br />
investigations, one size does not<br />
necessarily fit all. Whilst insurers deal<br />
with similar problems and processes<br />
in their investigations, they will all<br />
differ in the way of requirements and<br />
execution.<br />
Line of business will also affect this.<br />
<strong>The</strong> process flow of a motor theft<br />
investigation is different from a<br />
motor personal injury investigation,<br />
which is different from a home claim<br />
investigation, and so on. To enable<br />
investigators to handle their cases in<br />
the most efficient manner possible,<br />
the ability to tailor workflows to the<br />
specific needs of their business is<br />
vital.<br />
4. To further remove repetitive and<br />
time-consuming activities, providing<br />
the ability to connect to third<br />
party data and retrieve opensource<br />
intelligence to help build<br />
the case is an important benefit.<br />
In addition, certain activities can<br />
be automatically assigned to team<br />
members with the most appropriate<br />
skillset, enabling insurers to focus<br />
key activities on the investigators<br />
with the most experience.<br />
5. Having all of the information about<br />
an investigation in one centralised<br />
place - with all data gathered,<br />
captured and easily accessible -<br />
means that your management<br />
information is at your fingertips,<br />
informing decisions in real time<br />
rather than waiting for weekly<br />
or monthly reports. <strong>The</strong> granular<br />
information on outcomes means<br />
that effective feedback can be<br />
provided to your detection models.<br />
This can happen automatically if the<br />
solutions are integrated, resulting in<br />
rapid improvement in detection and<br />
precision.<br />
6. <strong>The</strong> IT department of any given<br />
insurance company is usually<br />
under pressure, faced with<br />
competing priorities from multiple<br />
departments. Consequently, adding<br />
data sources and making small<br />
changes to workflows can often<br />
take a while. SaaS solutions that can<br />
add data sources or deploy low/no<br />
code software are therefore most<br />
desirable, placing you in command<br />
of your own destiny as you manage<br />
your own system to reflect your<br />
ongoing changing requirements.<br />
A system with these attributes enables<br />
you to evolve into a slick and efficient<br />
Special Investigation Unit, handling<br />
cases with maximum efficiency as you<br />
focus your resources on areas where<br />
they will see the most benefit.<br />
Handling more cases allows you to<br />
gain a return on investment in both<br />
sides of the Case Management and<br />
Detection solution - making sure that<br />
honest customers who are subject to<br />
false positives are returned to normal<br />
processes as rapidly as possible,<br />
with good outcomes as required by<br />
Consumer Duty requirements. All<br />
the while, you will be gathering the<br />
feedback you need in order to improve<br />
your models going forward, ensuring a<br />
continuous cycle of improvement.<br />
Martyn Griffiths,<br />
Sales Manager UKI, FRISS<br />
<strong>Fraud</strong> <strong>Supplement</strong> 19
with Matt Gilham<br />
Whitelk<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> catches up with Matt Gilham, Director of Whitelk, to draw upon<br />
his vast knowledge of fraud prevention in insurance. In this exclusive Q&A, we discuss fraud<br />
prevention strategies, digital transformation, and the impact of Artificial Intelligence (AI) and<br />
Machine Learning (ML) on the insurance fraud landscape.<br />
Matt, you left your role as a fraud ‘SME’ within an<br />
insurer to set up your own insurance fraud consulting<br />
Q business. What common questions are you being asked<br />
at the moment?<br />
Headline questions fall into two main categories. Senior<br />
management seem to have a high-level interest in how<br />
A their company compares to its peer group, closely followed<br />
up by an interest in the steps that would be needed to become<br />
market-leading. <strong>The</strong>re’s also a broad and vigorous appetite for better<br />
understanding regarding the fraud-related benefits and risks attached<br />
to AI and Generative AI.<br />
Q<br />
A<br />
<strong>The</strong>y’re challenging questions! Is it right, and really<br />
all that possible, to compare firms and their fraud<br />
prevention strategies?<br />
Well, there are certainly wide variations in approaches and<br />
capabilities across organisations when it comes to managing<br />
insurance fraud. While many common themes, methods, and<br />
strategies exist, there’s no single right way to mitigate fraudulent<br />
activity, but often clear gaps, weaknesses or opportunities instead.<br />
In a sense, assessing an organisation’s maturity in fraud capability<br />
is relatively simple. For example, the relative clarity in strategy<br />
and structure form baseline foundations such as any missing key<br />
components across core operational deterrence, prevention,<br />
detection, investigation, and application of sanction – as well as<br />
maturity in critical enabling capabilities such as case management,<br />
intelligence, and MI.<br />
It’s more complicated to assess how fraud strategy and performance<br />
fits with broader business risk appetite and strategies, including how<br />
counter-fraud performance interacts with crucial business targets<br />
in quotability, conversion, retention, and claims indemnity control<br />
measures (such as third-party claim intervention).<br />
Some organisations have a natural appetite to be sector leaders,<br />
able to demonstrate how they are ‘winning at all’ across fraud,<br />
in combination with other business goals. Others appear more<br />
comfortable being mid-pack in capability – so long as they are happy<br />
that they are not being selected against, and can provide adequate<br />
reassurance to their leadership team!!<br />
Peer comparison on capability alone provides assurance, but leading<br />
counter-fraud performance is all about taking an overall, clear<br />
strategy forward, one that is aligned to the broader objectives of the<br />
business.<br />
You mentioned senior management’s interest in the<br />
benefits and risks of emerging AI in counter fraud. In your<br />
Q view, what impact will AI / ML have on the perennial fight<br />
against fraud?<br />
A<br />
While the impact and timing of AI use by fraudsters is still<br />
open to some debate, in my view, where there is an attractive<br />
‘cash out’ opportunity, fraudsters will almost certainly target a<br />
sector, a company or a process.<br />
I look at this from three primary angles. Firstly, how is AI / GenAI<br />
causing fraud threats to evolve? What vulnerabilities are created as<br />
insurers embed AI in their business-as-usual operations, and finally,<br />
how can counter-fraud technology keep pace?<br />
Focusing on threats, I’ve heard broad debate on the state of play<br />
regarding ‘bad’ GenAI. <strong>The</strong>re are polarised views on whether this<br />
remains an unproven potential risk, or whether it should be managed<br />
as a threat that is already in progress. However, evidence of the<br />
fraudulent use of synthesised speech, chatbots, and scale automated<br />
creation of fabricated documents and images is certainly emerging.<br />
For me, experience is often a great indicator of the near future. In<br />
2004, I dealt with an incident where an employee at a repairer was<br />
using MS Office Paint to fabricate additional damage in vehicle image<br />
photos. Although this incident was simple and quickly detected, it is a<br />
superb example of how fraudsters will misuse digital tools if they are<br />
available.<br />
Looking more to the present, a ChatGPT social media creator recently<br />
released a slide carousel showing how he created a university-level<br />
academic dissertation from simple prompts. His last slide caught my<br />
attention, as it prompted GPT to rewrite the entire document so that<br />
it did not look generated by AI, including an instruction to make a few<br />
spelling mistakes. So, Gen AI is definitely ready and primed to enable<br />
people to cheat!<br />
20 <strong>Fraud</strong> <strong>Supplement</strong>
It takes little imagination to see how AI can be used to generate<br />
digital media to support fraud. For example, AI could be used to alter<br />
metadata to make any form of image/document look as if it was<br />
created at the correct date, time, and geolocation of any incident.<br />
On the horizon, we also need to be aware of the emerging imbalance<br />
in the ability to use AI. Regulation to ensure the ethical and legal use<br />
of AI by businesses is entirely appropriate to protect consumers. It’s<br />
almost inevitable, whatever form it takes.<br />
Conversely, our fraudster opponents can exploit ‘bad’ AI to its<br />
maximum potential. We really must plan to counter the risk of being<br />
outgunned by their adoption of AI capabilities.<br />
Are there any immediate insurance fraud issues that<br />
insurers should be addressing when it comes to AI threats?<br />
Q<br />
<strong>Insurance</strong> fraud linked to identity theft is an in-progress threat,<br />
highlighting where fraudulent use of AI has the potential to<br />
affect insurers even further.<br />
A<br />
Across the variety of experts that I’ve spoken with, there’s a consensus<br />
that Gen AI will produce better quality phishing emails, automated at<br />
scale and more convincing than our present-day equivalent. This can<br />
easily lead to an increase in compromised and synthetic identity data.<br />
From an insurance underwriting perspective, we know synthetic<br />
identities and identity theft are already issues affecting book quality<br />
through a raft of pre-meditated application fraud typologies, with<br />
stolen credentials also being used to enable policy hijacking and<br />
account takeovers.<br />
Due to the likely downstream impact of Gen AI driving increased<br />
consumer data compromise, insurer capability around identity<br />
validation and verification across the customer, policy and claim<br />
lifecycle is most certainly a priority.<br />
Greater digital transformation has an increased risk<br />
of fraud for businesses and organisations across the<br />
Q insurance ecosystem. Is this consistent with what you are<br />
seeing too?<br />
A<br />
Yes, and it also builds on the threats posed by ‘bad’ GenAI.<br />
Having been at the heart of digital transformation within an<br />
insurer organisation, I’m acutely aware of the risks that rapid<br />
change presents, as well as the vast opportunities it affords.<br />
<strong>Insurance</strong> companies want to speed up decisions, processing, and<br />
customer interactions across the insurance lifecycle. Inevitably,<br />
there will be vulnerabilities created which will be exploited if left<br />
unaddressed. We have to accept that the digital channel will only<br />
become more attractive to fraudsters as insurers place more customer<br />
capability online, particularly in the form of sales, payments,<br />
servicing, policy changes, refunds, FNOL and settlement information.<br />
<strong>The</strong>se risks can be mitigated by ensuring that counter-fraud thinking<br />
and controls are included in an end-to-end transformation strategy.<br />
Areas worth considering on an enterprise level include ensuring data<br />
and events are captured and made available for decisions throughout<br />
the customer lifecycle, identifying how fraud capabilities in sales,<br />
servicing, and claims could be leveraged across these potential silos,<br />
and ensuring a focus on people leadership as well as technology and<br />
process changes.<br />
What advice would you give to insurance companies<br />
looking to improve their approach to managing fraud?<br />
Q<br />
A<br />
We should be really proud of our sector’s increasingly mature<br />
approach to fraud management. Our organisations have many<br />
skilled experts and some excellent, ambitious teams. However,<br />
I’d always encourage insurers to step back and take a full cross<br />
enterprise and customer lifecycle view.<br />
Our frontline leaders and their teams can sometimes get caught up<br />
in coal-face, ‘business-as-usual’ operational activities, with very little<br />
time to assess future opportunities as a consequence. <strong>The</strong>se teams<br />
must be supported and allowed the bandwidth to review strategy,<br />
test new approaches or innovative technology, and learn from across<br />
the business, peers, and other sectors.<br />
Linked to this is ensuring an overall enterprise view. Many firms<br />
already operate with a joined-up approach across all types of fraud,<br />
whether through a centralised team or through a more federated (but<br />
still coordinated) approach. Vulnerabilities arise in more legacy siloed<br />
processes.<br />
Firms fail to join up or leverage technologies and processes across<br />
application, policy, and claim fraud. Critical areas like payments and<br />
servicing are left unaddressed, and opportunities to reduce fraud are<br />
missed.<br />
This enterprise approach is even more critical at times of<br />
transformation, where data architecture, orchestration, and the<br />
ability to use data/intelligence assets across the end-to-end lifecycle<br />
become crucial to achieving top performance.<br />
About Whitelk<br />
Whitelk is a specialist consultancy that<br />
works with insurers, brokers, and MGAs<br />
to improve counter-fraud capability and<br />
reduce their total cost of fraud. It also<br />
advises data/technology companies<br />
and investors, such as private equity,<br />
to understand the fraud market and<br />
opportunities.<br />
Matt Gilham,<br />
Director, Whitelk<br />
<strong>Fraud</strong> <strong>Supplement</strong> 21
<strong>Fraud</strong> Recovery Litigation:<br />
A Powerful Tool in the<br />
Fight Against <strong>Insurance</strong> <strong>Fraud</strong><br />
In most fraudulent claims, there are usually two key drivers - need and greed. But the economic uncertainty of<br />
recent times has also driven opportunistic fraud, perpetrated by policyholders who once told us that they didn’t<br />
need the money, but who, on reflection, should perhaps have been smart enough to know better.<br />
Here are some recent examples which Crawford Legal<br />
Services has helped to uncover.<br />
A dentist pulling a fast one<br />
Following a four-day trial in May 2023, and at the conclusion of over<br />
two years of litigation, the court handed down judgment in relation<br />
to a fraud recovery action. <strong>The</strong> case involved Dr X, a dentist who<br />
was described by the court as ‘married to a GP, and at the time of<br />
the alleged wrongdoing was of comfortable financial circumstances’.<br />
He was found to have staged a road traffic accident and was held<br />
liable for his fraudulent misrepresentation.<br />
<strong>The</strong> road traffic accident was said to have occurred in April 2020. Dr<br />
X, assisted by an associate who was both a mechanic and accident<br />
management representative, cleverly used the COVID-19 lockdown<br />
as an excuse to block his motor insurer’s attempts to inspect the<br />
damaged vehicle. Calls to the insurer referred to the hard work<br />
that Dr X was conducting for the NHS, including unpaid overtime.<br />
This cynical plan worked, persuading the motor insurer to release<br />
payment for £48K - the pre-accident value of the car. This payment<br />
then triggered a secondary GAP claim, worth a further £31K if paid.<br />
Crawford Legal Services was instructed to validate the GAP claim,<br />
and the lies of Dr X quickly unravelled. <strong>The</strong> GAP claim was declined,<br />
but Dr X refused to pay his motor insurer back, forcing a fraud<br />
recovery action.<br />
One line of defence offered by Dr X was his comfortable financial<br />
position. Surely the court would not believe that a medical<br />
professional and family man with an unblemished record would<br />
be so stupid as to deliberately damage his car, risking his<br />
reputation and career for £80K? Clearly, that argument was seen as<br />
mouthwash – as we’ll see later.<br />
Doctoring a claim<br />
<strong>The</strong> dentist’s tale reminded me of another claim concerning an<br />
NHS locum GP, Dr A, resident of a leafy Hampshire suburb. With no<br />
known enemies, and in an apparently random attack, his BMW 750i<br />
was subject to arson. Dr A, on the pretext of filming wildlife in his<br />
garden, captured footage of an unknown male torching the BMW on<br />
his own driveway. Despite attendance from the fire brigade, the car<br />
was destroyed. Dr A’s motor insurer paid the claim without concern,<br />
but the GAP insurer was less convinced. Although the fire was<br />
presented as random and senseless, in the 46th month of a 4-year<br />
GAP policy, Dr A had a number of reasons to profit from the alleged<br />
total loss.<br />
A detailed investigation led to the unchallenged decline of the<br />
claim on the grounds that Dr A had orchestrated the deliberate<br />
destruction of his own car. Dr A argued that he was earning so much<br />
money from his role as a locum GP (plus rental income from three<br />
properties) that he didn’t have a financial motive to engage in fraud.<br />
In one sense he was right.<br />
Things that go bump<br />
At risk of repetition, Mr B - a motor and GAP policyholder from the<br />
less leafy suburbs of Manchester - ran a similar (if bizarrely frank)<br />
argument. Having parked his Audi S3 near his house as usual, a van<br />
then hit the unattended car, causing significant damage. <strong>The</strong> motor<br />
insurer paid without hesitation or concern. But for the GAP insurer,<br />
this incident fell on the last day of the 4-year policy term. <strong>The</strong> claim<br />
was declined, though Mr B claimed that he had no financial incentive<br />
to make a fraudulent claim for ‘just’ £20K, as he was making so<br />
much money from the growth and sale of cannabis…<br />
<strong>Fraud</strong> <strong>Supplement</strong> 23
Tony Dixon<br />
Head of Home Underwriting, Integra
An open and shutter case<br />
In another recent case, Crawford UK was instructed to loss adjust<br />
a commercial property claim made by a London based property<br />
firm. <strong>The</strong>ir East London shop/office premises, one of many in their<br />
portfolio, suffered a significant and genuine fire. <strong>The</strong> work began in<br />
order to return the property into its former state. <strong>The</strong> policyholder<br />
had received over £120k, but then, arguing that they disagreed with<br />
our contractor’s scope, asked for a further £30k to fund their own<br />
repairs.<br />
CFS was instructed to investigate, and it was found that the<br />
policyholder had forged their supplier’s invoice to ‘hide’ a totally<br />
new £10,000 steel roller shutter in the claim costs. Following this<br />
discovery, the indemnity position was reversed, and no further<br />
payments made. <strong>The</strong> policyholder issued proceedings, so CLS was<br />
instructed to defend. <strong>The</strong> case culminated with the policyholder<br />
repaying the entire claim and the policy being declared void. Now<br />
the business will need to declare its dishonest conduct, and will<br />
struggle to obtain property insurance cover going forward.<br />
<strong>The</strong>re’s no doubt that the economic uncertainty of recent times<br />
has driven many policyholders to undertake desperate measures.<br />
Insurers, across all lines, are reporting an increase in opportunistic<br />
fraud.<br />
But insurers should be alive to the possibility that insurance fraud is<br />
now being driven by the greed and arrogance of policyholders, both<br />
corporate and individual, who ought to know better.<br />
For many years, the staple diet for fraud practitioners has been<br />
cash-for-crash motor insurance fraud, invariably involving claimants<br />
and policyholders with little stake in society, and little by way<br />
of economic (or social) jeopardy associated with their conduct.<br />
Stamping out insurance fraud within communities, or among<br />
individuals with nothing to lose, can be frustrating for individual<br />
insurers and the central industry bodies.<br />
However, a combination of COVID-19 and economic downturn<br />
has driven a new generation of insurance fraudster. Driven by<br />
greed, by need, and sometimes both, Crawford Legal Services is<br />
seeing middle class, well educated, property owning and otherwise<br />
upstanding individuals engage in insurance fraud. Whilst this change<br />
in the demographic of the insurance fraudster ought to seriously<br />
alarm the insurance industry, such policyholders most certainly<br />
have something to lose. <strong>Fraud</strong> recovery actions, through litigation if<br />
necessary, represent a powerful tool in the fight against insurance<br />
fraud.<br />
It wasn’t necessary, however, to litigate against Mr & Mrs W,<br />
household policyholders living in Kent. <strong>The</strong>ir burglary, probably<br />
genuine, included a claim for a stolen watch. Three years later, they<br />
tried to sell the very same watch, leading to the discovery of this<br />
classic insurance fraud. Mrs W (an insurance broker!) and Mr W<br />
ought to have known better - Mr W felt it was ‘unfair’ that he should<br />
have to repay the entire claim (after all, he told me, he had never<br />
been dishonest in the past, expecting this to make his insurance<br />
fraud somehow acceptable). However, after seeking further legal<br />
advice, he quickly agreed to do so.<br />
Dr X, where we started, chose a different route. After confessing<br />
that the crash was fraudulent, he set about seeking to defend fraud<br />
recovery proceedings by employing expensive commercial solicitors<br />
to mount a campaign of aggressive tactical complaints and bitterly<br />
fought litigation, including four days in court, represented by King’s<br />
Counsel. Dr X now faces the prospect of repayment to his motor<br />
insurer, an enormous costs bill, exemplary damages to be assessed,<br />
committal proceedings for contempt of court, and professional<br />
disciplinary action - which will almost certainly lead to professional<br />
ruin. All this when, on his own evidence, he had no financial need to<br />
do so.<br />
In the past, insurers often viewed fraud recovery actions, probably<br />
correctly, as ‘good money after bad’.<br />
But the changing demographic of the insurance fraudster now<br />
makes fraud recovery actions a powerful tool in the fight against<br />
insurance fraud, and one that should be seriously considered.<br />
Peter Oakes,<br />
Head of Counter <strong>Fraud</strong>, Crawford & Company<br />
<strong>Fraud</strong> <strong>Supplement</strong> 25
with<br />
Paul Ridge,<br />
Q&ASAS<br />
We caught up with Paul Ridge,<br />
Head of <strong>Insurance</strong> – UK at SAS, to<br />
discuss the amplified risk of fraud<br />
in light of increasing digitisation<br />
across the industry, the pressures<br />
that <strong>Fraud</strong> Investigation Teams<br />
are facing at the moment,<br />
and some key findings from<br />
the recent Coalition Against<br />
<strong>Insurance</strong> <strong>Fraud</strong> survey.<br />
26 <strong>Fraud</strong> <strong>Supplement</strong>
Q<br />
A<br />
Let’s start by talking about the products and services offered<br />
by SAS in relation to fighting fraud within the insurance<br />
industry…<br />
SAS has been a familiar fraud solution partner to insurers all<br />
around the world for more than 15 years. Insurers’ data science<br />
teams can use our AI and analytics platform to develop their own<br />
fraud solutions, but we also offer complete detection and investigation<br />
solutions that meet the needs of every persona, from the data scientist<br />
to the fraud investigator, field agent and claims handler.<br />
As a recognised leader in fraud, but also in digital experience solutions,<br />
SAS are unique in being able to provide insurers with the ability to<br />
drive greater collaboration across marketing, claims, digital experience<br />
and fraud teams.<br />
With increased digitisation across the industry, are insurers<br />
making the landscape too easy for fraudsters?<br />
Q<br />
<strong>The</strong> challenge remains for any fraud detection strategy to<br />
maintain the balance between protecting their business and<br />
A delivering the services that their customers demand, all with as<br />
little friction as possible. <strong>The</strong> continual development of digital services<br />
and channels is inevitable, as these offer benefits to the insurer and<br />
the current or prospective policyholder alike. While digital channels<br />
may remove the opportunity to apply more traditional fraud detection<br />
approaches and ‘human intuition’, innovative new solutions are also<br />
available to protect insurers.<br />
Insurers are continually evaluating new ways of detecting fraudulent<br />
behaviours from data enrichment, applying scoring and profiling across<br />
digital quote, customer management and claims journeys. That being<br />
said, fraud teams aren’t always successful in securing the funding to<br />
invest in these capabilities, as current market conditions influence<br />
the prioritisation of growth in market share, cost reduction or loss<br />
prevention.<br />
Current trends in inflation and pricing will drive an increase in<br />
opportunistic fraud alongside the more organised criminal activity.<br />
This will be seen in quote manipulation (to try and rapidly drive down<br />
increasing premiums) or claim exaggeration. <strong>The</strong>se behavioural trends<br />
are potentially exacerbated when dealing with a faceless digital<br />
process; therefore, insurers need to continually apply techniques which<br />
influence those behaviours, as they can be harder to detect.<br />
Q<br />
A<br />
What other pressures are <strong>Fraud</strong> Investigations Teams under<br />
at the moment, and how can the efficiency of their processes<br />
be improved to alleviate this strain?<br />
<strong>Insurance</strong> fraud detection and investigation teams operate in<br />
a heavily regulated and highly competitive industry. Navigating<br />
both of these constraints to successfully prevent fraud losses<br />
can certainly be a challenge – constraints that organised criminals<br />
needn’t worry about! For insurers, this creates a pressure to find<br />
cost effective solutions that also comply with industry regulation on<br />
data privacy, ethics, and transparency in AI-driven decision making.<br />
Cross-organisation collaboration could be one way to alleviate these<br />
pressures. By way of example, collaboration between <strong>Fraud</strong> teams and<br />
Customer Experience or Marketing teams can lead to joint investment<br />
strategies and cohesive customer strategies, neither of which can be<br />
found when using solutions that only serve the purpose of one team.<br />
To elaborate further on this point, let’s look at fraud detection in<br />
digital customer journeys. In the case of customer acquisition,<br />
insurers will have digital transformation, customer experience and<br />
marketing leaders investing in marketing technology to develop<br />
experiences that differentiate from those of the competition. Trends<br />
here include increasing investment in technology vendors to capture<br />
data from digital journeys, creating segmentation approaches and<br />
then personalising the customer experience. We’ve also seen the rise<br />
of ‘Customer Data Platform’ (CDP) providers, giving marketeers a place<br />
to capture a wide range of data to help inform marketing strategies.<br />
<strong>The</strong>se ‘martech’ solutions can include the use of decision engines with<br />
combinations of rules or scoring that take customers on prescribed<br />
journeys, with the aim of maximising conversion from quote to<br />
purchase.<br />
Most often, Marketing and Customer Experience departments are<br />
working in isolation to the <strong>Fraud</strong> teams, when in reality, there are many<br />
reasons why they should be collaborating. Whether it be for customer<br />
acquisition or ongoing customer management of the claims journey,<br />
both sides of the coin can deliver more cost effective and cohesive<br />
approaches. This may require stakeholders to consider technology<br />
partners in new ways, meeting the needs of both fraud and marketing<br />
functions, but also bringing data and decisions together to support<br />
the goals of both sides. Instead, we see duplication of spend, friction<br />
between leadership teams, and fragmentation that ultimately impacts<br />
customer experience as well as the detection of fraud.<br />
Tell me more about the key findings from the Coalition<br />
Against <strong>Insurance</strong> <strong>Fraud</strong> survey…<br />
Q<br />
We have worked with the Coalition Against <strong>Insurance</strong> <strong>Fraud</strong> for<br />
a number of years; we collaborate to review fraud technology<br />
A trends in the US insurance industry. This study looks at the use<br />
of technology across personal, commercial and other lines of business,<br />
and can provide great insight into the rate of adoption. As an example,<br />
we look to understand how insurers are applying anti-fraud tools, such<br />
as automated alert generation, predictive modelling, reporting and<br />
visualisation, case management, anomaly detection, and also advanced<br />
network analytics.<br />
What this study also gives us is an understanding of the barriers that<br />
insurers are experiencing when looking to implement fraud solutions.<br />
<strong>The</strong> most obvious challenges relate to the limited IT resource that<br />
insurers have to support implementation (70% of responders) and the<br />
quality of the data captured, alongside the speed with which this can<br />
be accessed and integrated into any solution.<br />
While this study looks at the US market, there are always similarities to<br />
other markets - such as the UK. <strong>The</strong> insurance market is made up of a<br />
wide range of product lines and portfolios, each with its own demands<br />
and fraud risks. However, we can see that the use of analytics is on the<br />
rise across almost all markets.<br />
Q<br />
Finally, is transparency and collaboration the best way<br />
forward when it comes to sharing fraud intelligence and<br />
assessing risk within the wider industry? What are the<br />
arguments for and against this?<br />
I absolutely believe it is, and this is continually proving to<br />
be effective in any location. We have supported a number of<br />
A insurance fraud consortiums around the world as they collaborate<br />
cross-industry in the sharing of data. <strong>The</strong> <strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB)<br />
here in the UK have always been a great example for the rest of the<br />
world in demonstrating how this can be effective. Our work with the<br />
IFB explores new and innovative ways to advance this collaboration,<br />
resulting in continued success for the IFB and its members.<br />
<strong>The</strong> continued success for data sharing (and the consortiums that<br />
support this) will require careful consideration of regulations around<br />
data privacy, ethics, and how data is applied for fraud detection<br />
purposes. This can relate to basic governance and quality controls<br />
around the data they receive, to more complex topics such as the<br />
emerging regulations of AI and the models and data they are trained<br />
upon. <strong>The</strong> EU AI Act, alongside other regulation, will continue to develop<br />
at pace to ensure that automated decisions and the data used by AI<br />
is fair and free from bias. Everyone has a duty of care to ensure that<br />
innocent customers do not experience any discrimination or harm in our<br />
fight to stay one step ahead of the criminals who prey upon them.<br />
Paul Ridge,<br />
Head of <strong>Insurance</strong> - UK, SAS<br />
<strong>Fraud</strong> <strong>Supplement</strong> 27
AI vs.<br />
FRAUD<br />
<strong>Fraud</strong> is a constantly<br />
changing threat to the<br />
insurance industry, with<br />
a significant impact<br />
on the bottom line,<br />
customer satisfaction,<br />
and society as a whole.<br />
But does AI hold the<br />
key to effectively<br />
combatting fraud?<br />
<strong>Insurance</strong> is ubiquitous in modern society,<br />
and accounts for over 7% of the world’s<br />
economic activity. <strong>The</strong> exact origins are<br />
difficult to pinpoint, but we know that<br />
insurance dates back to at least 1750 BC,<br />
with the Babylonians and the Code of<br />
Hammurabi. This code, consisting of 282 laws<br />
carved onto a stone monument, established<br />
standards for commercial interactions,<br />
including some that related to the concept of<br />
risk and insuring against it. While fraud isn’t<br />
mentioned specifically, we can safely assume<br />
that it has been present for as long as<br />
insurance itself, and the two are inextricably<br />
linked throughout history.<br />
Today, technological advancements - coupled<br />
with the post-pandemic cost-of-living<br />
crisis - have caused people to turn to fraud<br />
out of desperation as well as opportunism.<br />
From opportunistic fraud to ghost-broking<br />
and exaggerated claims, we’re seeing<br />
familiar forms of fraud on the rise, not just<br />
in insurance but across all industries. More<br />
concerning still is the emergence of new<br />
types of fraud - behaviours we haven’t seen<br />
before that evade our current methods for<br />
containment. According to a recent report<br />
by PwC, 70% of companies surveyed say<br />
that they have experienced new types of<br />
fraud since COVID-19. <strong>Fraud</strong> is evolving and<br />
spreading, and as it does, so too must our<br />
measures for counteracting it.<br />
How much is fraud costing<br />
insurers, and what are they<br />
doing about it?<br />
According to the AFI, the UK alone could<br />
be losing up to £219billion every year to<br />
fraudsters, 72% of which is within the private<br />
sector in industries like insurance. For any<br />
insurer, paying out on fraudulent claims<br />
doesn’t just damage the business financially;<br />
it also affects the lives of individuals who<br />
are either victims of fraud directly, or end up<br />
having to pay higher premiums as the costs<br />
are passed down.<br />
Currently, insurers are using a range of<br />
methods in their fraud detection efforts.<br />
Most have a team of claims handlers that<br />
manually assess a group of claims, looking<br />
for the telltale signs of fraud. However,<br />
relying entirely on an in-house team of<br />
claims handlers makes scaling their work<br />
challenging and costly. If you want to detect<br />
more fraud, you’ll need to hire and train<br />
more people. Also, you can’t avoid the fact<br />
that human error will play a part, and every<br />
fraudulent claim that gets past your team<br />
affects your bottom line.<br />
Insurers can address some of these<br />
challenges by employing algorithms that are<br />
programmed with rules to analyse huge sets<br />
of claims, flagging those that fulfil specific<br />
criteria for further investigation. However,<br />
the accuracy of these algorithms is limited<br />
28 <strong>Fraud</strong> <strong>Supplement</strong>
y the specific nature of the rules with which<br />
they are programmed. Reprogramming these<br />
algorithms with new rules for new fraud<br />
types is a step in the right direction, but it is<br />
both time-consuming and expensive.<br />
Consequently, many insurers look to the<br />
SaaS market for off-the-shelf fraud solutions.<br />
But this kind of SaaS is typically expensive,<br />
and whilst they sometimes perform initially,<br />
the solutions providers are often slow to<br />
update them as new types of fraud emerge.<br />
In most cases, this requires you to pay<br />
the provider to return and update their<br />
solution themselves. This can take months<br />
or years, and represents an added cost to<br />
the business. <strong>The</strong> fact that the intellectual<br />
property (IP) of the solution belongs to<br />
the SaaS provider also means that any IP<br />
advantage that one insurer might experience<br />
when they discover something unique in<br />
their sector gets eliminated, as it gets<br />
shared equally by all their competitors<br />
using the same solution. Since insurance<br />
is so competitive, expensive off-the-shelf<br />
SaaS products that don’t provide a business<br />
advantage are impossible to justify.<br />
yet it represents unforeseen and unplanned<br />
capital expenditures that extend the amount<br />
of time it takes for the solution to achieve its<br />
expected ROI.<br />
What insurers really need<br />
Truly effective fraud detection requires a<br />
single solution that combines the strengths<br />
of all these approaches whilst mitigating<br />
their weaknesses. Insurers need a solution<br />
that integrates their unique business<br />
operations and domain expertise with the<br />
data-processing power of an algorithm,<br />
but with the ability to learn new rules and<br />
patterns from the data itself - rather than a<br />
reliance on reprogramming.<br />
<strong>The</strong>y need a solution that is intuitive,<br />
means-tested, and easy to use (like SaaS),<br />
but one that is more agile and adaptable,<br />
with the opportunity to retain IP to maintain<br />
a competitive advantage. With this kind of<br />
solution-specific AI, insurers can achieve<br />
unprecedented levels of accuracy in a way<br />
that augments the abilities of their teams,<br />
detections of fraudulent claims by 120% and<br />
increasing referrals retained by the fraud<br />
department by 800%.<br />
This definitively shows that, when adopted<br />
effectively, the right AI solution can add<br />
real and lasting value in the fraud detection<br />
space. <strong>The</strong> key to the solution’s success<br />
was the way it was customised to AND-<br />
E’s specific requirements, enabling the<br />
claims team to interact with it in order to<br />
understand how and why recommendations<br />
are made. Human-AI collaboration is a<br />
fundamental aspect of real-world successful<br />
AI adoption in insurance.<br />
We cannot predict what new kinds of<br />
insurance fraud might emerge in the coming<br />
years. However, we do know that AI won’t<br />
just play a pivotal role in combatting these<br />
new fraud types; it will be integral to the<br />
future of the insurance industry as a whole.<br />
If insurers can successfully combine their<br />
own teams’ experience and skillset with<br />
AI’s unparalleled data-processing power,<br />
Given the shortcomings of these<br />
approaches, it’s no surprise that so many<br />
insurers are turning to custom-built AI<br />
solutions as a more effective means of<br />
detecting and combatting fraud. AI’s<br />
extraordinary capacity for ingesting,<br />
processing, and identifying patterns and<br />
anomalies within vast quantities of data<br />
makes it uniquely suited for this purpose.<br />
Today, insurers who don’t have the time or<br />
resources to build their own in-house data<br />
science teams are turning to consultancies<br />
to unlock this value. But this comes with its<br />
own complications. Even though machine<br />
learning (ML) models represent a more<br />
intelligent approach to detecting fraud,<br />
these ML models are also susceptible to<br />
changing patterns of human behaviour, often<br />
suffering a significant decline in performance<br />
over time. Studies have actually found that<br />
91% of models decay within the first year,<br />
post-deployment.<br />
When that happens, the only way to bring<br />
a model back to day-one performance is to<br />
retrain it or rebuild it. Retraining requires<br />
expertise that may not be available inhouse,<br />
and consultants with the relevant<br />
skill set will almost always recommend the<br />
more expensive option, like rebuilding the<br />
model with the latest techniques so that its<br />
new operating performance is even better<br />
than it was before. Since we all want the<br />
best, this can be a convincing argument,<br />
allowing AI to become reliable and trusted<br />
partners in the process of detecting fraud.<br />
An example of this can be seen in a solution<br />
that Mind Foundry recently built for our<br />
customer Aioi Nissay Dowa Europe (AND-E).<br />
AND-E required a unique fraud detection<br />
and prediction solution based on their<br />
own specific requirements that no off-theshelf<br />
solutions could meet. <strong>The</strong> end result<br />
empowers AND-E’s claims experts to identify,<br />
prioritise, and investigate fraudulent activity<br />
by analysing a vast set of claims, alongside<br />
ingesting over seven years of data - including<br />
20 million unstructured documents - to<br />
determine which ones showed signs of<br />
potential fraud.<br />
<strong>The</strong> most relevant claims get flagged and<br />
prioritised in an investigations dashboard;<br />
therefore, AND-E can resolve them in order<br />
of the likelihood that they contain actual<br />
instances of fraud. As new patterns emerge,<br />
the solution automatically and continuously<br />
integrates data back into the model using<br />
a Continuous Metalearning capability -<br />
improving performance and governing risks<br />
over time, rather than decaying like so many<br />
other machine learning models.<br />
This has led to AND-E saving 2% on capped<br />
indemnity spend in 2022. <strong>The</strong>y are also on<br />
track to double that in 2023, increasing the<br />
then they will be able to unlock the best<br />
outcomes for both their customers and their<br />
business.<br />
Selim brings close to 25 years of<br />
experience delivering data, IT and<br />
research-based solutions to the insurance<br />
sector. Previously, Selim has worked at<br />
Ingenie, LexisNexis, Experian, and AXA.<br />
He’s an associate of<br />
the Chartered<br />
<strong>Insurance</strong><br />
Institute and has<br />
worked with<br />
industry bodies<br />
like SepNet,<br />
promoting STEM<br />
subjects across<br />
the UK.<br />
Selim<br />
Cavanagh,<br />
Director of <strong>Insurance</strong>,<br />
Mind Foundry<br />
<strong>Fraud</strong> <strong>Supplement</strong> 29
<strong>Insurance</strong><br />
Providers<br />
can be First<br />
Responders<br />
in the Fight<br />
Against <strong>Fraud</strong><br />
Earlier this year, the UK Government launched their fraud strategy. This includes<br />
the the ambition to reduce fraud by 10% by 2025 compared with fraud levels in<br />
2019, as well as a new national fraud squad and the prioritisation of fraud within<br />
the police force. Yet, as opportunistic insurance fraud grows amid the cost-of-living<br />
crisis, insurance professionals cannot afford to wait. Career criminals, including ghost<br />
brokers, continue to adapt and evolve to target any weaknesses in the system, while<br />
opportunistic fraud is tempting for a population under financial strain.<br />
However, balancing the scales between assessing risk<br />
and excelling at customer service can be tricky. <strong>The</strong> vast<br />
majority of insurance customers are honest with nothing to<br />
hide; understandably, they will not welcome clunky fraud<br />
checks that slow down service, nor will they appreciate<br />
being tarred with the same brush as fraudsters. Instead,<br />
insurance professionals seeking to stamp out fraud must<br />
look for red flags without impacting the streamlined ‘quote<br />
and buy’ experience the market has worked so hard to<br />
deliver over the past few years.<br />
This may not be as difficult as it sounds.<br />
Is the customer new or known?<br />
It starts with leveraging the customer data that the<br />
insurance provider already holds, which will help to confirm<br />
a person’s identity at a base level. With one source of<br />
accurate, up to date and de-duplicated customer data<br />
accessible throughout the customer journey, insurance<br />
providers can use data enrichment more successfully to<br />
flag the possible signs of fraud, signs that could be missed<br />
through more basic checks. Of course, the benefits of<br />
effective customer data management go well beyond fraud<br />
detection to support all aspects of frictionless service<br />
provision, from quote to claim.<br />
<strong>The</strong> challenge is that while most insurance providers<br />
have a wealth of information on their customers, more<br />
often than not it can be fragmented and in organisational<br />
silos. For example, a customer may have multiple policies<br />
within different lines of business without the dots being<br />
connected, or a recent merger or acquisition may even<br />
present the challenge of customer data coming from two<br />
different companies.<br />
Consolidating data will help insurance providers to check<br />
that the customer is who they say they are. In addition, as<br />
the insurance industry becomes more person, rather than<br />
policy, centric, it can help companies to deliver products<br />
more suited to the needs of their policyholders.<br />
Tackling this issue, linking and matching technology<br />
is now being used by a growing number of insurance<br />
providers to amalgamate all their data and ultimately build<br />
<strong>Fraud</strong> <strong>Supplement</strong> 31
a single customer view. By compiling data from multiple<br />
touchpoints - be that quote, renewal, claim or marketing<br />
- previously disparate records are linked together using a<br />
common identifier (such as LexID® for <strong>Insurance</strong>) to enable<br />
a holistic, company-wide view of each customer.<br />
Meanwhile, new YouGov findings published by the<br />
<strong>Insurance</strong> <strong>Fraud</strong> Bureau (IFB) show that as many as one in<br />
four young adults would ‘likely’ consider an act of insurance<br />
fraud if they were struggling financially. In light of this,<br />
there is certainly an escalating need for insurance providers<br />
to recognise quote manipulation.<br />
Revealing the risk of quote manipulation<br />
Types of quote manipulation vary widely, and may seem<br />
innocuous to the policyholder. However, the deliberate<br />
misstatement of key facts - for example, where a vehicle is<br />
parked overnight - is illegal, and risks a policy being void at<br />
claim. So, as more people may consider risking a ‘white lie’<br />
on their insurance applications, insurance providers need to<br />
ascertain the probability of this happening.<br />
By connecting and comparing thousands of insurance<br />
quotations from across the market, it is now possible<br />
to uncover changes between quotes in key fields that<br />
are prone to manipulation, helping to support insurance<br />
providers in uncovering potential fraud. LexisNexis®<br />
Quote Intelligence does just that, helping to spot possible<br />
inaccuracies prior to policy inception.<br />
<strong>The</strong> IFB’s latest public awareness campaign, <strong>Fraud</strong><br />
Cons, aims to educate consumers on the devastating<br />
consequences that fraud can have on those tempted to<br />
make fraudulent applications and claims. In the meantime,<br />
LexisNexis Quote Intelligence can uncover fraud by helping<br />
insurance providers to root out the problem themselves. In<br />
doing so, this also helps to keep the cost of policies down<br />
for the honest consumer.<br />
Email intelligence flags links to fraud<br />
<strong>The</strong> humble email address also features heavily in the<br />
sector’s fight against fraud. It is one of the most common<br />
components of an online transaction, not to mention a<br />
unique identifier, so it makes perfect sense for insurance<br />
providers to use this source to verify an individual’s<br />
identity via the digital footprint that goes with it. By<br />
assessing billions of transactions from global payment<br />
processors, email fraud risk scoring solutions such as<br />
LexisNexis® Emailage Rapid can gauge the risk associated<br />
with a customer’s email address, as well as other personal<br />
information provided during the application process.<br />
Individuals are then accurately placed into <strong>Fraud</strong> Risk<br />
Bands and issued with a predictive risk score. In this<br />
way, email address intelligence has benefits for detecting<br />
front-end insurance fraud such as ghost broking, while<br />
speeding up the customer experience for those who are<br />
automatically approved in real time.<br />
Front-end fraud is not the only target for opportunistic<br />
fraudsters. In 2022, the number of referrals for<br />
opportunistic claims received by the City of London<br />
Police’s <strong>Insurance</strong> <strong>Fraud</strong> Enforcement Department<br />
increased by a staggering 82% from the previous year.<br />
With this in mind, insurance providers would benefit from<br />
gathering as much information as possible regarding an<br />
individual’s past claims, which can help to inform the<br />
potential scope for fraudulent activity.<br />
Claims history uncovered for the individual<br />
and the asset<br />
That capability is almost here, with the launch of<br />
LexisNexis® Precision Claims in early-2024. As a cuttingedge<br />
market-wide contributory claims database, the new<br />
contributory data solution will confirm past claims for both<br />
the individual and the asset - including the value of the<br />
claim and the settlement details - offering the market’s<br />
very first view of home and motor claims in tandem. By<br />
highlighting previously undisclosed claims, it will help to<br />
support accurate risk assessment and assist the market in<br />
their attempts to avoid fraud.<br />
<strong>The</strong>re is no silver bullet to beating fraud. <strong>The</strong> industry will<br />
always require a need for collaboration and innovation,<br />
with multi-pronged strategies to identify red flags at<br />
every point of the insurance journey. As the ABI’s<br />
Assistant Director, Head of <strong>Fraud</strong> and Financial Crime,<br />
said: “While it is good to see the industry’s collaborative<br />
efforts deliver results in 2022, there can be no room for<br />
complacency. With many households and businesses<br />
continuing to face rising costs, now more than ever honest<br />
customers expect insurers to weed out the cheats and<br />
focus on paying genuine claims as quickly as possible.”<br />
It is clear that those insurance providers who exploit<br />
data driven solutions to uncover fraud at source, all while<br />
improving the customer experience, will stand the best<br />
chance of keeping fraudsters at bay without compromising<br />
valued relationships with honest customers.<br />
1 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/<br />
attachment_data/file/118480/national-fraud-strategy.pdf<br />
2 https://www.abi.org.uk/news/news-articles/2023/8/crackdown-on-insurancecheats-delivering-results-but-average-scam-up-to-nearly-15000/<br />
3 https://www.which.co.uk/news/article/the-most-common-types-of-insurancefraud-and-how-to-fight-your-corner-if-you-fall-victim-a6F0T5S0mYjY<br />
4 https://www.cityoflondon.police.uk/news/city-of-london/news/2023/april/<br />
ifed-shows-that-opportunistic-insurance-fraud-does-not-pay-as-cost-of-livingpressures-drive-surge-in-cases/<br />
5 https://insurancefraudbureau.org/media-centre/ifb-news/2023/new-yougovfindings-show-growing-number-of-young-adults-tempted-by-insurance-fraud<br />
6 https://insurancefraudbureau.org/fraud-cons<br />
7 https://www.cityoflondon.police.uk/news/city-of-london/news/2023/april/<br />
ifed-shows-that-opportunistic-insurance-fraud-does-not-pay-as-cost-of-livingpressures-drive-surge-in-cases/<br />
8 https://www.abi.org.uk/news/news-articles/2023/8/crackdown-on-insurancecheats-delivering-results-but-average-scam-up-to-nearly-15000/<br />
Martyn Mathews,<br />
VP personal and commercial lines,<br />
UK and Ireland for LexisNexis Risk<br />
Solutions, <strong>Insurance</strong><br />
<strong>Fraud</strong> <strong>Supplement</strong> 33
Charles Taylor:<br />
‘An entire fraud ecosystem’<br />
<strong>Modern</strong> <strong>Insurance</strong> <strong>Magazine</strong> catches up with Bobby Gracey, Global Head of<br />
Counter <strong>Fraud</strong> at Charles Taylor, to discuss their inimitable blend of human skill<br />
and automation, their widespread product offering, and their unique approach to<br />
fraud investigation across multiple aspects of insurance.<br />
QBobby, you are the Global Head of Counter <strong>Fraud</strong> at<br />
Charles Taylor. What does that role entail?<br />
ACharles Taylor provides insurance services, claims solutions<br />
and technology platforms to the entire global insurance<br />
market, supported by offices in over 30 different countries.<br />
As Global Head of Counter <strong>Fraud</strong>, I head Charles Taylor’s Specialist<br />
Investigation Services - a multi-product fraud investigation and<br />
claims validation resource for our international businesses and<br />
wider multi-sector insurers. We support all lines, including those not<br />
traditionally associated with fraud, such as high net worth, marine,<br />
aviation, trade credit, political risk, construction, and engineering.<br />
My role helps ensure that Charles Taylor maintains and develops<br />
its market leading response to countering insurance claims fraud<br />
throughout our global operating locations. As a team, we work<br />
directly with clients to mirror their strategic needs and fully<br />
understand their specific tolerance to risk.<br />
Integral to this is constantly developing Charles Taylor’s global<br />
counter fraud capabilities; for example, with our recent acquisition<br />
of Contego Investigative Services in the US. This provides our US<br />
colleagues with direct access to over 350 licensed investigators,<br />
supplying both field and surveillance services. We’ve also recently<br />
enhanced our intelligence led approach by acquiring <strong>Fraud</strong>Keeper,<br />
an exciting new start-up tech from Argentina that enables Charles<br />
Taylor to offer our own proprietary machine learning automated<br />
fraud detection software to our clients.<br />
Day-to-day, my role involves everything from overseeing our most<br />
complex operational investigations, to supporting Charles Taylor’s<br />
global business development and identifying new companies or<br />
technologies suitable for acquisition. Daily, I draw on outstanding<br />
talent within the Charles Taylor business, not least from our Director<br />
of Investigation Services in the UK, Simon Cook. In addition, my<br />
position as Chairman of the Chartered Institute of Loss Adjusters<br />
(CILA) Anti-<strong>Fraud</strong> Committee enables me to bring a wider<br />
perspective to the role.<br />
After 35 years in insurance, I am as enthusiastic today as I was<br />
all those years ago. During this time, the insurance industry has<br />
made great strides in raising awareness of the cost and impact of<br />
fraud on policyholders and shareholders alike. At Charles Taylor,<br />
we’re continuing to innovate and collaborate to help eradicate this<br />
longstanding issue.<br />
QCharles Taylor Specialist Investigation Services are awardwinning<br />
experts in multi sector fraud investigations. Tell<br />
me more about this work!<br />
AIn the last three years, the insurance industry has recognised<br />
us for our operational investigation services, and for the<br />
innovative counter fraud technologies that we’ve brought<br />
to market. As mentioned earlier, Charles Taylor has pioneered fraud<br />
investigation solutions for insurance lines that have not, historically,<br />
been associated with fraud. Today, we describe ourselves as an entire<br />
fraud ecosystem.<br />
Amongst our innovative counter fraud technologies is ‘Discovery,<br />
by Charles Taylor’. Available in numerous global locations, both in<br />
English and Spanish, Discovery has truly disrupted the sector by<br />
enabling ethical and legal data gathering from over 200 social media<br />
and open-source sites worldwide. Its unique technology reviews<br />
unstructured content to gather impactful data; helping claims<br />
professionals and investigators to make better decisions when it<br />
comes to identifying fraud or validating claims.<br />
Discovery also delivers outstanding cost and process efficiencies,<br />
converting around 30 hours of manual investigation time into a<br />
30-minute interactive process. Investigators can therefore spend<br />
34 <strong>Fraud</strong> <strong>Supplement</strong>
more time on impactful, rather than routine, tasks. Discovery is also<br />
highly scalable and can process around 10,000 reports per month, a<br />
far cry from manual searches.<br />
Meanwhile, our automated fraud detection software, <strong>Fraud</strong>Keeper,<br />
has been successfully deployed across South America, and we’re also<br />
focused on leveraging this technology further in European and North<br />
American markets. This will help to better detect fraud, understand<br />
fraud trends, and future-proof fraud prevention.<br />
Last but not least, by acquiring US-based Contego Investigative<br />
Services, we’re meeting growing counter fraud needs in the USA,<br />
onboarding hundreds of US investigators and enabling these US<br />
services to grow significantly under our ownership.<br />
QSo, give me some examples of what your toolkit of<br />
investigation products consists of!<br />
AOur counter fraud toolkit is all inclusive. It ranges from<br />
intelligence led background checks and automated<br />
fraud detection software, to social media reviews, field<br />
investigation and surveillance services.<br />
Probably one of our best kept secrets is the scale of our international<br />
investigation capabilities. This area of our investigation toolkit has<br />
been developed over the last 15 years, with Charles Taylor Assistance<br />
evolving to become the recognised market leader in global travel<br />
claims management.<br />
In developing our toolkit, we recognise that return on investment<br />
is fundamental to clients. We know that the key to all investigative<br />
solutions is to constantly review performance versus operating costs<br />
and market requirements. We also appreciate that no two insurers<br />
have the same fraud philosophy, or even tolerance to risk.<br />
Our proactive approach means we’re always on the lookout for new,<br />
innovative technologies and operational solutions to help identify<br />
and combat claims fraud for our customers.<br />
QHow does your strategic operational response utilise<br />
technology?<br />
AAt Charles Taylor, we endeavour to be intelligence led in our<br />
decision-making and processes. That being said, we firmly<br />
believe that harnessing our existing human capital of ‘IQ’ is<br />
the best strategic approach, juxtaposed with our ‘IT’. One cannot fully<br />
perform without the other, and this blended approach ensures that<br />
our clients benefit from the best of both worlds.<br />
By adding our automated fraud detection software (<strong>Fraud</strong>Keeper),<br />
and our open source and social media digital intelligence tool<br />
(Discovery) to our portfolio of counter fraud services, we’ve<br />
successfully harnessed technology that complements our human<br />
skills. Importantly, because we own this technology ourselves, we can<br />
be nimble in its deployment - avoiding delays caused by third parties<br />
changing algorithms or updating software.<br />
When it comes to AI, the current industry debate on benefits vs.<br />
disadvantages remains interesting.<br />
AI is an area that all industry<br />
leaders need to better understand<br />
and consider, but it’s clear that<br />
it can be utilised by fraudsters<br />
and crime fighters alike. So, the<br />
onus is on the insurance industry<br />
to develop AI strategies that<br />
are several steps ahead of both<br />
organised and opportunistic<br />
fraudsters. Above all, the counter<br />
fraud sector can never stand still.<br />
Reach out to Bobby via email<br />
for more information:<br />
bobby.gracey@charlestaylor.com<br />
<strong>Fraud</strong> <strong>Supplement</strong> 35
Navigating the complexities of<br />
<strong>Insurance</strong> <strong>Fraud</strong> in the UK<br />
and Unmasking Current Trends<br />
<strong>Insurance</strong> offers<br />
protection and peace<br />
of mind to millions<br />
of individuals and<br />
businesses. However,<br />
the insurance<br />
landscape in the<br />
UK is not without its<br />
challenges, one of the<br />
most significant being<br />
motor insurance fraud.<br />
As insurance<br />
investigators, we’re<br />
always on the lookout<br />
for fraud and are all too<br />
aware of the known<br />
trends, including staged<br />
and contrived collisions<br />
as well as suspicious<br />
single-vehicle claims.<br />
But more recent trends,<br />
such as ghost broking<br />
and cash-for-crash<br />
scams involving moped<br />
riders, are now plaguing<br />
the industry as newer<br />
types of fraud evolve.<br />
<strong>The</strong> Cost of<br />
<strong>Insurance</strong> <strong>Fraud</strong><br />
Before delving into specifics, it’s important<br />
to understand the impact that insurance<br />
fraud can have on the UK economy and its<br />
citizens. Estimates put the annual cost of<br />
fraud in the UK in the billions of pounds. This<br />
financial burden is ultimately borne by honest<br />
policyholders, who see their premiums rise<br />
due to fraudulent claim costs.<br />
Understanding the motivation behind<br />
insurance fraud is crucial. Individuals and<br />
organised crime groups (OCGs) engage<br />
in fraudulent activities for various reasons,<br />
including financial gain, perceived opportunity,<br />
or desperation. Trends in UK insurance fraud<br />
continue to evolve. Most are a variation on<br />
a theme that we’ve seen many times over<br />
the years; however, some recent trends<br />
are concerning with regards to the level of<br />
organisation, as well as the potential impact<br />
on innocent members of the public.<br />
Ghost Broking<br />
Ghost Broking is a term coined for a scam<br />
whereby the broker appears to be genuine,<br />
but proves extremely difficult to pin down<br />
to a specific location. Typically, fraudulent<br />
individuals pose as legitimate insurance<br />
brokers or agents, targeting vulnerable<br />
motorists in search of affordable coverage.<br />
<strong>The</strong>se ‘Ghost Brokers’ operate at the<br />
intersection of deception and exploitation,<br />
often preying on young members of society,<br />
on immigrant communities as well as<br />
inexperienced drivers who are more likely<br />
to fall victim to their ‘too good to be true’<br />
schemes. <strong>The</strong>y claim to offer insurance<br />
policies at unbelievably low rates to<br />
entice unsuspecting victims, often forging<br />
addresses, contact details and insurance<br />
certificates, with all the obvious outcomes.<br />
Victims unwittingly pay for these fraudulent<br />
policies, all too often believing that they<br />
are adequately insured when they are not.<br />
Oftentimes, this deception is only discovered<br />
when a road traffic collision occurs and<br />
an insurance claim is instigated, the<br />
consequences of which can be dire.<br />
DLB Investigations have further concerns<br />
around a new and developing trend, where<br />
the details of a genuine individual or company<br />
are cloned. Those details are then used to<br />
incept a false fleet policy in order to ‘insure’<br />
voluminous numbers of genuine vehicles.<br />
Links to large-scale OCGs are common here,<br />
and our investigations have revealed that the<br />
genuine entity is invariably unaware of the<br />
policy, or the vehicles covered by it.<br />
An alarm bell often sounds when the victim<br />
is notified of insurance claims, or receives<br />
numerous penalty notices for vehicles they<br />
know nothing about. Unfortunately, these<br />
claims and fines are attributable to the<br />
innocent victim because their details are<br />
obtained from the MID database.<br />
Crash for Cash<br />
<strong>The</strong>se scams, associated with deliberate<br />
rear-end induced crashes, are well-publicised<br />
and have been around for some time. But this<br />
has now morphed into a worrying new trend<br />
involving moped riders, who ‘crash’ head-on<br />
into an unsuspecting motorist driving a car<br />
or van.<br />
We’ve seen this dangerous new development<br />
explode over the past two years into<br />
something akin to an epidemic. Criminals<br />
intentionally causing accidents is nothing<br />
new, but appearing to ride headfirst into<br />
an unsuspecting motorist certainly is! <strong>The</strong><br />
motivation behind these scams is clear:<br />
financial gain through fraudulent insurance<br />
claims.<br />
Our recent investigations at DLB have<br />
uncovered many such claims. Through<br />
collaboration with other agencies, we’ve been<br />
instrumental in gathering key intelligence<br />
and evidence to identify how the scam<br />
works, as well as who is likely to be behind it.<br />
36 <strong>Fraud</strong> <strong>Supplement</strong>
<strong>Fraud</strong>sters are not easily deterred, and yet<br />
despite collective efforts, the scam continues<br />
apace.<br />
<strong>Fraud</strong>sters frequently feign injuries (no real<br />
injury is ever suffered) for maximum gain,<br />
as well as exaggerated vehicle damage<br />
to ensure that a replacement moped is<br />
supplied, frequently via inflated credit hire<br />
schemes. Often, fake witnesses are also<br />
provided, adding a degree of faux legitimacy<br />
to the claim.<br />
All of this adds further cost-layering to<br />
the claim that is presented to an innocent<br />
motorist’s insurance company. Contesting<br />
such a claim can be difficult for insurers,<br />
not to mention potentially intimidating for<br />
policyholders. Insightful intelligence from an<br />
experienced investigations company can<br />
often be central to a successful outcome.<br />
Combatting <strong>Insurance</strong> <strong>Fraud</strong> in<br />
the UK<br />
<strong>The</strong> fight against insurance fraud in the<br />
UK is a multifaceted battle, one that<br />
involves cooperation among insurers,<br />
suppliers, enforcement agencies and other<br />
stakeholders alike. Numerous strategies can<br />
be employed to detect and prevent fraudulent<br />
activities.<br />
<strong>Insurance</strong> companies are increasingly<br />
harnessing the power of data analytics to<br />
identify suspicious patterns and anomalies<br />
in motor claims data. Deploying the right<br />
technology allows investigators to quickly<br />
triage claims, highlighting potentially<br />
fraudulent ones for further investigation.<br />
As a progressive and forward-thinking<br />
company, DLB Investigations constantly<br />
challenge the status quo and look for<br />
innovative investigative solutions. For<br />
example, our Rapid Triage of Claims (RTC)<br />
service aims to shift the investigative process<br />
as close to FNOL as possible, in order to<br />
gather fresh, timely and meaningful evidence.<br />
At the other end of the claims investigation<br />
process is Helix, our forensic vehicle data<br />
service. Helix extracts and analyses data<br />
stored in modern vehicles, and invariably<br />
delivers irrefutable evidence to validate or<br />
reject a claim.<br />
However, no one should rely on technology<br />
alone; software can only do so much! That’s<br />
where human interaction via specialists, such<br />
as investigation companies, plays a crucial<br />
role in showing the policyholders that their<br />
insurer is not just a faceless entity.<br />
From our own experiences at DLB, the mere<br />
mention of a professional investigator coming<br />
to visit a policyholder can be enough to make<br />
a would-be fraudster think twice about their<br />
actions, or even withdraw a spurious claim.<br />
In Conclusion…<br />
<strong>The</strong> landscape of insurance fraud in the<br />
United Kingdom is complex and continually<br />
evolving. It’s a financial and social concern<br />
that demands immediate attention and action.<br />
Technology can help. Specialist investigators<br />
can also help. <strong>The</strong> right combination of both<br />
can prove pivotal.<br />
One proven way to deter fraudsters is for<br />
insurance companies to be seen to be<br />
investigating claims diligently to uncover<br />
fraud. As investigations specialists, we can<br />
show how human and tech resources already<br />
save some UK insurance companies millions<br />
of pounds every year by providing data<br />
that lets them repudiate fraudulent claims. I<br />
believe that others should follow – not simply<br />
to save money, but also to highlight our<br />
diligence to criminals who play the system.<br />
<strong>The</strong>y won’t succeed, and will be brought<br />
to book. At DLB, we know how to help the<br />
system bite back.<br />
David Booker,<br />
Managing Director, DLB Investigations Ltd<br />
<strong>Fraud</strong> <strong>Supplement</strong> 37
How can the insurance<br />
industry manage the internal<br />
risk of fraud?<br />
An insurance policy is one of those strange purchases, something that we buy but never plan to use. If the worst does<br />
happen however, we expect the voice on the other end of the phone to be somebody that we can trust in our hour of<br />
need, somebody that will help us to navigate the complexity of our claim. We wouldn’t think for a moment that they<br />
may use us as a way to obtain an unlawful benefit for themselves.<br />
Last year, cases filed to the Cifas Internal <strong>Fraud</strong> Database<br />
rose by nearly 10% when compared to the previous year,<br />
with around 40% of these cases filed for employees stealing<br />
information, money and equipment.<br />
Employees within the insurance sector are no different to any<br />
other sector when it comes to dishonest conduct. <strong>The</strong>y have<br />
a variety of information available at their fingertips, and can<br />
identify potential loopholes to exploit for their own gain. It isn’t<br />
as obvious as diverting claims money to their own accounts;<br />
there are those that are willing to sell confidential information<br />
as to get away with making false claims. In addition, there are<br />
employees willing to sell the data of claimant policy holders<br />
to third parties in order to pursue legal action on behalf of a<br />
potentially injured individual, not to mention those taking a cut<br />
from a payout in exchange for processing a fraudulent claim.<br />
Now more than ever, organisations need to ensure that they<br />
have defences in place to protect against the insider threat.<br />
External factors have never been greater, with large numbers<br />
of employees working from home and hybrid working as<br />
we face the second winter of a cost-of-living crisis. If we are<br />
pushed enough, I believe that all of us have the inclination to<br />
be dishonest. Thankfully, most of us will never hit that point,<br />
but those that do may find themselves motivated to commit<br />
fraudulent conduct in an attempt to keep their head above<br />
water. Faced with this circumstance, many rationalise their<br />
behaviour by convincing themselves that they should have<br />
received a pay increase or a bonus, or they are taking on more<br />
responsibilities as companies struggle to find the budget to<br />
replace colleagues that have been made redundant or left. A<br />
lack of investment in technology or a reduction in employee<br />
numbers can also leave gaps, which enables employees to<br />
commit fraud against their employer.<br />
Collaboration is key to organisations when it comes to fighting<br />
the insider threat. Organisations must create an opportunity to<br />
talk about the threats and fraud trends that they are facing, as<br />
well as confirming the integrity of potential candidates who are<br />
applying for roles alongside that of existing employees.<br />
In 2022, 42% of cases filed to our Internal <strong>Fraud</strong> Database<br />
involved false employment applications – up by nearly a<br />
quarter from the previous year.<br />
Cases of this type are increasingly using ‘reference houses’<br />
when applying for new roles, meaning that previous<br />
employments can effectively be hidden as a result of the<br />
applicant paying for a false reference. Many of these<br />
‘reference houses’ offer an additional service whereby they will<br />
impersonate a candidate’s previous employer to give them a<br />
positive reference over the phone.<br />
Cifas Insider Threat Protect is the only solution in the UK that<br />
helps organisations to identify and stop dishonest conduct by<br />
job applicants and employees within the workplace.<br />
Through cutting-edge<br />
data, intelligence and<br />
learning, Insider Threat<br />
Protect is the complete<br />
solution to helping<br />
businesses prevent,<br />
detect, and defend<br />
against internal fraud, as<br />
well as other security risks<br />
that frequently originate<br />
within an organisation.<br />
linkedin.com/<br />
company/cifasuk<br />
twitter.com/<br />
CifasUK<br />
38 <strong>Fraud</strong> <strong>Supplement</strong>
Specialist<br />
Investigation<br />
Services<br />
Innovative solutions<br />
to help validate claims &<br />
combat insurance fraud<br />
Charles Taylor Specialist Investigation Services (CTSIS) works<br />
collaboratively with the insurance industry to provide market<br />
leading global claims validation and counter fraud services.<br />
Our full suite of claims validation solutions includes<br />
<strong>Fraud</strong> Keeper, our proprietary Automated <strong>Fraud</strong><br />
Detection software, our multi award winning social<br />
media and open source intelligence tool, Discovery by<br />
Charles Taylor, both of which are supported by internal<br />
and external counter fraud professionals.<br />
GET IN TOUCH<br />
Bobby Gracey<br />
Group Head of <strong>Fraud</strong><br />
Find out more<br />
+44 7557 774 577<br />
bobby.gracey@charlestaylor.com<br />
Simon Cook<br />
Director of Investigation Services – UK<br />
+44 7834 098 648<br />
simon.cook@charlestaylor.com
www.insurancecxawards.com<br />
Awards Ceremony 07.02.24<br />
Proud Embankment, London<br />
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