The Red Flags of Fraud
- Red Flags are only indicators of fraud.
- They are not evidence of fraud
- They are not proof of fraud.
- They are tools to help claims handlers identify potential fraud for further investigation.
- When more than three substantial red flags appear in a claim investigation it should be referred to the SIU for further investigation.
What Do You Do When Red Flags Appear?
If your investigation establishes more than three red flags of fraud prepare a report and request for service to your SIU.
- Advise the insured or claimant that additional investigation is required with a detailed explanation in compliance with the Fair Claims Practices Regulations.
- Advise the insured that the investigation has been referred to Mr. ______ __________ or Ms. ______ __________ without identifying the person as an SIU investigator.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts