Investigating Claims: Detect Fraud and Abuse
Course Overview
Fraudulent claims raise the price of insurance for everyone, so it’s in a company’s best interest to verify that every claim is legitimate and accurate. Car accidents, personal injury, workplace injury and property damage are all common insurance claims that require an investigation.
The claim handling process involves three primary elements: "‹ investigation"‹, "‹ evaluation,"‹ and settlement (disposition)"‹. This course focuses on investigation: gathering pertinent details about the claim to determine whether the loss is covered.
Learning Objectives
After you complete this course, you will be able to understand: -
- The three basic steps used to investigate property and casualty claims; verifying coverage, obtaining information about the claim and verifying and comparing this information;
- How to handle claims so that the information gathered during the investigation can be used as evidence in court;
- How to determine whether an insured is legally liable for loss,
- What types of laws may be involved in auto liability claims?
- Specific steps to follow when investigating auto liability, workers’ compensation, fire and ‘fall down’ claims.
- Why it is important to ensure claims are genuine before paying out.
