In our current environment the key to survival for an organisation depends on their ability to see the bigger picture and this is particularly so for insurance companies and claims agencies.
Claims are ongoing on a daily basis regardless if it is worker’s compensation, life insurance, public liability or third party and these will be a loss for the organisation in a monetary and or productivity level.
Insurance companies or any other corporation that has the need for surveillance investigation must prior to conducting a surveillance investigation need to determine what is the objective and what information is to be obtained from social engineering about the claimant in order to produce a quality intelligence finding that is the backbone for a successful investigation. Without determining what is the objective and what information is to be collected, any investigation not just the surveillance is set to fail and this will result in additional costs to the organisation.
Fraudulent claims are unfortunately a daily occurrence, it is happening and it will continue to happen. A fraudulent claimant will develop new skills, they work hard at getting new information, learning new techniques and tactics on how to avoid to be under surveillance, being undetected or how to go about ensuring that a surveillance becomes illegal.
Why are fraudulent claims not detected? It is very simple; they know what you need to see to approve their claim.
Saying that the claims managers must understand and must keep up to date with new trends on the market on how fraudulent claims occur. The claims managers need to know how the social environment and changes in the claimant’s social behaviour could be a fraudulent claim. By not being aware of these practices can create losses and increase costs for the corporations and insurance companies.
Surveillance Investigation is a most effective way of investigating POI’s (person of interest) and best way to not approve or decline the claim and recuperate losses via legal channels.
The most fundamental concept of an investigation for any organisation is the intelligence cycle: planning, gathering, analysis and dissemination. This cycle contains all of the elements required to produce actionable surveillance investigations.
By developing the Intelligence Cycle and Action Plan for Surveillance Investigations it will certainly create a new base for reducing fraudulent claims due to the fact that you will know more about how to analyse intelligence in preventing fraud and setting up a benchmark for your organisation in reducing losses and costs.
Planning investigation will consist mostly from tactical information collected. Tactical intelligence will not assist case managers in making the ultimate decision and that information will not predict future social behaviour or social environment of fraudulent claims, however it will determine the decision if surveillance investigation is needed and when to start.
Gathering intelligence or the collection plan is very important part of the intelligence cycle, due to the fact that case managers will collect information from open sources about the claimant and as well it is important to grade the intelligence information collected on whether it’s from a reliable source. It is very important that case managers be creative and not to rely on some sources of information as it can be deceiving.
Analysis Analysis is the intelligence process which converts raw data and information into intelligence making it available for analysis. Processing includes validating data and making key points about the claimant, social behaviour and environment. Analysed intelligence can be used later for actioning: comparing previous claims, trends, social behaviour etc.
Dissemination is the process where the case managers provide in the form of a referral on information about the claim, the claimant and the objective, precisely stipulating how and when the surveillance is to be conducted.
Applying Intelligence Cycle and Actioning Plan for Surveillance Investigations, will with no doubt bring results desirable for your organisation.
Information converted into intelligence can be used in Strategic Intelligence Cycle which will certainly make case managers jobs easier and prevent fraudulent cases and reduce costs and losses for the organisations and insurance companies