26/07/2019

Red Flags, red flags everywhere!

Last Friday I was involved in an RTA on the M62. It was a terrifying experience, but thankfully my son and I, walked away from the accident without serious injury. The same cannot be said for my car.

This RTA is my second in eight months.

In the insurance fraud industry we often talk of red flags and key fraud indicators when assessing claims and accident circumstances. These are generally behaviours or inconsistencies which suggest a claim may not be entirely genuine and closer scrutiny is required. A big red flag is recent similar accidents i.e. two RTAs in an eight month period.

On paper, I am a potential fraudster.

To be clear, I’m not fraudster. I am however unfortunate enough to have been involved in two non-fault accidents in a very short space of time. It happens.

Many of the fraud indicators relate to what appear to be unlikely coincidences, for example:

  • Recent similar accidents
  • Accidents without witnesses
  • Accidents occurring in remote location

The reality however, is that sometimes there are genuine reasons or explanations for these 'coincidences'. Equally, it may be that the claim is fraudulent and the claim ought to be investigated and challenged accordingly.

Red flags and indicators are necessary parts of fraud detection. The skill and experience of validation teams quickly assess where indicators are false positives and this is a key part of what insurers do. Beyond that the investigation process builds the evidence so that insurers challenge the right claims in the right way. This protects innocent people (like me) from false accusations and everyone from the cost of insurance fraud. It’s all about strong processes built around sound strategy. 

As fraud lawyers, we also remain live to the need to validate genuine claims. This is an important part of our role as it ensures our time is quite rightly focused on challenging the dishonest claims effectively, robustly and commercially.

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