Fraud Prevention
This internal policy requires employees to report suspected fraud immediately.
What is Fraud Reporting Policy
Submitting a false or exaggerated claim for an injury that never happened is an example of this.
What is Insurance fraud?
Insurers sometimes use this technique to confirm whether an employee’s injury is legitimate.
What is Surveillance?
Fraud costs organizations worldwide an estimated ____ percent of their annual revenues, which amounts to billions of dollars every year.
What is 5%?
Source: NICB, Association of Certified Fraud Examiners (ACFE)
The number one Motivation for committing Fraud.
What is personal gain/income?
2016 66%, 2020 83%, 2024 90%
If an email urges immediate action and asks for confidential information, it is likely this type of scam.
What is phishing?
When multiple parties conspire to stage an accident for financial gain, it is known as this kind of fraud.
What is a staged accident?
When an employer misclassifies employees as independent contractors to pay lower premiums, it’s called this.
What is premium fraud or employee misclassification?
Workers Compensation Fraud Accounts for $_____ in Insurance losses annually
What is $34 billion?
This number includes $9 billion in insurance losses from fraudulent workers’ compensation claims, as well as $25 billion in losses due to workers’ compensation premium losses.
Source: Insurance Coalition, NICB $30 Billion
The three elements to fraud are _____, _____, and ____
Opportunity, Pressure, and Rationalization
The tool used to discover claims history
What is ISO
This term describes intentionally misrepresenting facts to obtain a benefit one is not entitled to under an insurance policy.
What is material misrepresentation?
In New York these laws deal with the construction industry safety especially for those who work at an elevated height.
What is New York Labor Laws
In property many claims are estimated to be fraudulent and casualty insurance, about 1 in ________
What is 1 in 10 claims or 10%
Source NICB and Coalition Against Insurance Fraud
Looking into the future of fraud, what are Two elements needed to combat fraud at ZCIS?
What is Engagement and Technology.
The process of reviewing previous claims history to spot patterns of abuse is known as this.
What is claims analysis or data analytics?
What are the top three forms of workers compensation fraud?
Claimant, Provider, Premium
Insurance fraud costs the U.S. $_____billion annually.
What is $305.6?
Coalition Against Insurance Fraud
These organizations offers free courses, to further education on trends and schemes.
NICB National Insurance Claim Bureau
NICTA -National Insurance Crime training Academy
When an employee repeatedly files claims for minor injuries, it’s known as this pattern.
What is frequent filer or serial claimant?
Doctors or clinics that repeatedly submit inflated medical bills for minor injuries may be participating in this.
What is medical provider fraud or billing fraud?