loading
The latest thinking and expert insights into the insurance industry.
14 June 2016
  |  
profile-img

Fighting insurance fraud effectively by aligning underwriting and claims

Annemieke Smith is Head of the Fraud & Integrity department at Reaal Insurance. After years of experience at the Claims department, her focus now is to protect Reaal against (potential) fraudsters. They have improved their fight against insurance fraud by aligning underwriting and claims.

Norms and values form the basis of a healthy insurance portfolio; they are the (unwritten) rules that define the responsibility of both the insurer and the insured. Take the balance between risk, insurance premium and payout. We call it dishonest if someone does not abide by the rules. Whether it concerns setting fire to one’s own shop because business is going badly, or a father taking out car insurance in his own name for the Golf GTI of his 19-year-old son who has just acquired his driving license. It is tempting, considering the difference in premium. However, that difference also applies to the risks that need to be covered.

Fraud awareness

alignment-underwriting-and-claims-to-fight-insurance-fraudIt is not always possible to prevent fraud, but I am convinced that greater fraud awareness can make a huge difference. So that is what we have focused on over the past years at Reaal.

Traditionally the departments Underwriting and Claims operate separately from each other to avoid potential conflicting interests. An excellent principle, but there are some drawbacks. It pays off to be alert to possible inconsistencies in a policy application. This improves the risk assessment at underwriting. Who is the actual owner and who is the main driver of a car? What is the history of a shop premises; does the present owner have connections with the previous owner who went bankrupt? Are there other reasons for taking out property insurance than just covering fire? Have the business results been bad or has there been a bankruptcy in the past?

All these signals are not directly reasons to refuse an insurance policy. The signals should at least lead to a realistic risk assessment with the appropriate premium. Also, when a claim is filed, the questionable points in the story can be checked more easily.

Cooperation Underwriting and Claims

There are two important reasons why our colleagues from the departments Underwriting and Claims should work closer together.

Firstly, we have shifted our focus from fraud detection to fraud prevention. This requires greater fraud awareness from the colleagues at Underwriting. Therefore, on a monthly basis, we share several examples of fraud that we have come across in our investigations. It usually concerns large premeditated cases, such as arson. We also discuss cases that fall under a somewhat ‘grayer’ area, such as including earlier parking damage in a claim following a collision, or stating that an iPad slid off the kitchen table while it was actually dropped outside. By sharing these examples, the staff gets a realistic idea of fraud and thus gains insight into how they can contribute to its prevention.

Cooperation between underwriting and claims is crucial to fight claims fraud

The second reason for more cooperation is the procedure for dealing with cases where fraud has been proved. Not only is the claim rejected and registered at the Dutch Association of Insurers. The relationship with the client is terminated as well. This last measure calls for the expertise of Underwriting: they know the policies, the terms and the rules for termination. In collaboration with Claims, a plan of action is made, taking into account the severity of the fraud. Then one single letter is sent out to the client. It contains all the details about the rejection and the registration of the claim, and the termination of the relationship.

Currently, Reaal has separate departments for Underwriting and Claims. In the near future, these will be replaced by departments per product. But whatever organogram you choose, I believe cooperation is crucial for optimal fraud prevention. It enhances the profitability of the insurances and raises the fraud awareness of the entire company to a higher level. We see this as an important result of the 1,5 year that we have been working in this manner.

Contact us

Cookie and Privacy Policy

1. Introduction

When you use this website, FRISS may collect information about your use of the website and the content offered. We believe it is important to handle your (personal) data with due care and confidentiality. When processing your personal data, we comply with the General Data Protection Regulation (Algemene Verordening Gegevensbescherming) and Article 11.7a of the Telecommunications Act (Telecommunicatiewet).

1.1.  Controller

The controller of the processing of personal data is:

FRISS Fraudebestrijding B.V.
Orteliuslaan 15
3528 BA
Utrecht

This processing of personal data is registered with the Dutch Data Protection Authority (Autoriteit Persoonsgegevens) in The Hague under reporting number m00004997.

1.2.  Purposes of data processing

There are several places on our website where you can fill in your (personal) data. We will explain the purposes of the various instances of data processing below.

Filling in the contact form or sending an e-mail

If you fill in the contact form on our website or send us an e-mail, we will only use the (personal) data you provide for the purpose or purposes for which you filled in the contact form or sent the e-mail.

Download form

If you download files on our website (such as e-books, whitepapers or reports), we will use the (personal) data you provide for one or more of the following purposes:

  • for the execution of an agreement, for example to send you the e-book, whitepaper or report you have chosen;
  • for the formation of an agreement, for example by contacting you by telephone or in writing.

Newsletter

If you fill in the application form for the newsletter on our website, your (personal) data will be used to send you the newsletter. Each newsletter contains a hyperlink at the bottom of the message that you can use to unsubscribe.

In addition to the personal data you provide to FRISS yourself, FRISS may collect, record and process additional (personal) data if you use the (web) services of FRISS. This concerns the following personal data:

  • data from the used equipment, such as a unique device ID, version of the operating system and settings of the device you use to access a service;
  • information about the use of a service, such as the time at which you use the service and the type of service that is used;
  • location details from your device or derived from your IP address that is provided to us when you use a particular service;
  • data available from external sources. We may receive information about you from public or commercially available sources.

1.3.  Provision of (personal) data to third parties

Your (personal) data will never be provided to third parties without your permission, unless we have an obligation to do so pursuant to legislation or regulations or you have given permission for this.

1.4.  Security of data

FRISS respects your privacy and ensures that personal data are handled confidentially and with the utmost care. All processed (personal) data is stored exclusively in secure databases. These databases are only accessible to employees of FRISS, to the extent that this access is required by virtue of their position. FRISS makes every effort to secure these systems against loss and/or any form of unlawful use or processing.

1.5.  Inspection, correction and deletion of data and the right to object

You can view your data that is processed by FRISS at any time and free of charge and, if you so wish, modify this data or have it deleted. You can also object to receiving information about products, services or content of FRISS. If you wish to make use of one of these options, you can send an e-mail to the Data Protection Officer of FRISS via privacy@friss.eu or write to the following address:

FRISS | fraud, risk & compliance
Attn. Data Protection Officer
Orteliuslaan 15
3528 BA Utrecht.

2. Cookies

When using this website, information about your use of these services and other websites may be collected by or on behalf of FRISS, for example by means of cookies.

A cookie is a small file that is sent along with pages of a website and stored by your browser on the hard disk of your computer. We use cookies to remember settings and preferences. You can disable these cookies via your browser.

2.1.  The purposes for which FRISS uses cookies

On our website we use cookies for the following purposes:

  • for statistical purposes, in order to analyse the use of FRISS websites. This allows us to keep track of the number of visitors and see which parts of our website are popular. We use Google Analytics in order to track and consult these statistics. On this website you can find explanations about all cookies that may be placed by Google;
  • for what is known as ‘targeting’ purposes, if you have used the download form. By targeting we mean building a profile of you based on your surfing behaviour on our website, after which we may contact you by telephone or e-mail based on the interests you have shown in order to offer you FRISS services that you may be interested in. We use HubSpot in order to track and consult these statistics. On this website you can find explanations about all cookies that may be placed by HubSpot;

3. Changes to this Cookie and Privacy Statement

FRISS may make changes to this Cookie and Privacy Statement. All modifications will be published on this page. We advise you to consult this Cookie and Privacy Statement regularly, so that you are always aware of the content of the current Cookie and Privacy Statement.

 

Subscribe