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What should you do if something about a claim does not feel right, even if you cannot identify a specific fraud indicator?
Anything that does not feel right should be referred
What due date should be set when creating an SIU referral?
Next working day
What is meant by an induced accident?
An induced accident is a collision that has been deliberately caused, often for financial gain through an insurance claim
Who is responsible for fraud awareness at Hastings Direct?
Everyone
How can fraud impact honest customers?
Fraud can increase the cost of claims and lead to higher insurance premiums for genuine customers
Name two scenario where you would refer a claim to FPV
- Fire
- Theft
Who can commit insurance fraud?
Customers, third parties, and organised criminals can all commit insurance fraud
What information should be included in the description when creating an SIU referral?
The reason for the referral
What activity must be created when referring a claim to the Claims Triage Team (CTT)?
SIU Referral activity
If an SIU referral was previously created and resulted in NFA, can another referral be created?
Yes, each claim is assessed against multiple criteria and a new referral may meet the required criteria even if a previous one did not
Who should an SIU referral be assigned to?
CTT Holding Pot
Name 4 scenarios that would require a referral to CTT
- Induced accident
- Drug abuse
- Alcohol abuse
- Late night accident (after 9pm)
- Early morning accident (before 6am)
What are fraudulent claims?
Fraudulent claims involve exaggerating, inventing, or deliberately causing incidents to receive insurance payouts
What referral would you create in the below scenarios:
PH has parked his vehicle to go shopping, upon return he has seen someone trying to break into his vehicle. The PH scared the thief away and notified the police. The PHV has long deep scratches on the OSF door.
Nothing.
It was an attempted theft and there are no concerns that would warrant a referral at this time.
What can you use for additional support if you are unsure which referral activity is to be created and who it should be assigned to?
Indemnity & Repudiation SOP
What would you select on Guidewire to create a SIU referral?
Actions → Investigations → SIU Referral
What is Ghost Broking?
Ghost Broking is when fraudsters sell fake or invalid insurance policies while pretending to be legitimate brokers
What is Identity Theft in relation to insurance?
Identity Theft is when criminals steal someone's personal information and use it to take out an insurance policy
What is meant by Fronting?
Fronting is providing incorrect information about a vehicle's main driver to reduce insurance premiums
Name 3 reasons why is it important for Hastings Direct to prevent and detect fraud?
- Protect honest customers
- Reduce financial losses
- Maintain trust and reputation
- Support legal and regulatory compliance
- Protect customer data