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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 />

Sponsorship Enquiries: rachael.pearson@charltongrant.co.uk<br />

Event Enquiries: millie@charltongrant.co.uk<br />

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