Leading the Fight Against Insurance Fraud

A recent article in Forbes highlighted what agents know all too well: insurance fraud is a pervasive problem in the insurance industry. Fraud is the second-most expensive white-collar crime in the U.S., costing over $300 billion annually—equating to $900 per consumer.

Insurance fraud can be hard fraud—a deliberate act to collect money, such as by staging or faking an accident—or soft fraud—exaggerating a legitimate claim to increase a payout. Regardless of the type of fraud involved, Acuity works to detect and fight it, and our Special Investigations Unit (SIU) leads this effort.

“Our investigators have a diverse background of training, experience, and advanced certifications. When fraud is suspected, our team uses industry databases, social media, technology, and old-fashioned detective work to combat it to ensure our honest customers don’t end up paying the price,” says Special Investigations Unit Manager Michael Rindt.

Fighting fraud

Agents. Independent agents are an essential frontline defense, detecting when something isn’t right and forwarding it to us for investigation—a suspicious claim, an insurance certificate that doesn’t seem legitimate, and more.

Claims Representatives. Acuity’s fraud analytics model provides real-time information on whether fraud may be associated with a claim. Claims representatives use this information and their training and experience to determine whether to refer a claim to the SIU.

Underwriters. Underwriters are another important frontline fraud defense. Backdating coverage is a common type of fraud reported by underwriting.

Analytics. In addition to assisting claims personnel in evaluating claims, the fraud analytics model can identify those claims that have a high propensity to be fraudulent and notify the SIU of these claims immediately, allowing for early review and intervention if necessary.

Everyone! We all can play a part in combating insurance fraud! If you suspect fraud, call our hotline at 800.242.7666.

Our investigations have resulted in referrals to state and local authorities and successful criminal prosecution. Together, we are leading the fight against insurance fraud!