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Lewis, James W. and Delwiche, James C. Proof Of Fraud Without an SIU: Techniques and Methods Of Investigation By the Insurer Without One. The National Society Of Professional Insurance Investigators. 1997 Advanced Insurance Fraud Seminar - November 20, 1997.

Abstract: This article is the summary of a seminar given in Cincinnati, Ohio in November 1997. The seminar was designed to help smaller insurance companies that do not have a SIU (special investigations unit) to protect themselves against fraud. The article outlines a new corporate structure and philosophy to assist smaller companies in identifying fraudulent claims.

All personnel should be experienced in the field of investigating fraudulent claims. Experience is necessary to compensate for size. This means time and expense must be devoted to training all staff, not only those in the claims department. In a small company, the chain of command needs establishment and experienced staff should be placed in charge of every claims case.

The small insurance company must be willing to investigate potentially fraudulent claims. Expenses must be devoted to hiring experts, forensic accountants, and counsel. Decisions to deny or pay claims should be made in a timely manner with the proper considerations made for the consequences of those decisions.

Smaller insurance companies also need to take advantage off all resources available to them. Not all suspicious claims can be thoroughly investigated. The claims personnel must carefully select which claims have the greatest likelihood of yielding positive results for the company. There are several organizations that can assist in this process. The Property Insurance Loss Register, National Insurance Crime Bureau, and The Index System can all help narrow down the potentially fraudulent claims list.

 
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