«Insurance Forensic»: a new product for insurance companies 10.03.2016

«Insurance Forensic»: a new product for insurance companies

Expert Discovery has launched a new forensic product for insurers – «Insurance Forensic».

In the sphere of insurance fraud we may not confine ourselves to external insurance fraud by ignoring possible collusion of insureds and insurance company employees. According to All-Russian Insurance Association, in as little as the year 2014 the insurers paid to fraudsters more than 50 billion Rubles that is twice as many as in the year 2010. In the coming years we anticipate a further increase in fraud activities, especially involving organized crime groups. It is worth noting that corporate fraud with participation of insurance company staff accounts for up to fifty percent of the above damage.

In addition to traditional approaches and instruments used to implement fraud management, the Expert Discovery team applies forensic methods such as:

  • Fraud Detection & Prevention System (FDPS) – development and subsequent implementation of a specific add-in in the insurance company ERP for the automatic detection of losses and the insured risks that may be very likely caused by fraud;
  • Closed File Review (CFR) – stratified sampling of closed files for the mass insurance (CASCO, MTPL, VMI, etc.) and the file documentary review plus analysis of data from insurance company electronic systems for finding the ways for loss reduction;
  • Claims Settlement Assistance (CSA) – independent evaluation of above-limit and abnormal losses, especially those carrying reputation consequences for insurers: (1) special investigative activities; (2) elaboration and implementation of measures aimed to reduce insurance claim payments; (3) legal support and lawyers’ services in judicial proceedings;
  • Computer Forensics – (1) extraction and analysis of data from corporation mobile devices and work computers; (2) analysis of integration and access rights for various databases;
  • Compliance and Fraud/Corruption Management Services in accordance with Russian and international laws on prevention of corruption/bribery (FCPA, UKBA).

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