Is the rate of fraud growing or are we getting a grip?

“Yes and yes. Fraud seems to rise and fall inversely to the economy. Insurance fraud investigators are developing more tools, but those who commit fraud are inventive, as well. It is up to us to stay one step ahead of the fraudsters.”

1. Gene A. Weisberg, Principal, Gladstone Michel Weisberg Willner & Sloane. CLM Member since 2010.

“Both! While SIUs and law enforcement have been successful in detecting, denying, and deterring fraud, lying for financial gain is still a quick and easy way to pad one’s wallet. New schemes are developed daily, and we need to evolve quickly to fight career claimants, suspect providers/contractors, and unscrupulous attorneys.”  

2. Cathy Gicker, SIU Litigation Specialist, Allstate Insurance Company. CLM Fellow since 2011.

“Some types appear to be growing, such as medical and auto premium fraud; others seem to be in check. It’s almost impossible to say for sure because good data is lacking. Are more people committing fraud? Or are we just getting better at detecting it? Probably a little of both.”

3. Dennis Jay, Executive Director, Coalition Against Insurance Fraud. CLM Fellow since 2012.

“Insurance fraud certainly is on the rise, especially in auto casualty, workers’ compensation, and general liability. Although there have been great strides made against fraud, the industry still has a way to go in coordinating a fraud response to achieve a common purpose.”

4. Larry Henning, SVP, Special Investigations, G4S. CLM Fellow since 2011.

53%

Percent of SIU directors who say fraud has increased in the last three years.
Source: Coalition
Against Insurance Fraud

62%

Percent that Florida staged accident questionable claims decreased from 2010-2013.

Source: NICB

55%

Percent of North American insurers that see a rise in workers’ comp fraud rings.

Source: FICO

69%

Percent of insurers that say people commit fraud because they think they’ll get away
with it.

Source: Accenture

20%

Percent of North American insurers that cited predictive analytics as best tool to fight fraud.

Source: FICO