It doesn't need to be a bridge too far - Insurium

Bridging the Management GAP in Escalating Insurance Claims

While insurance fraud schemes have evolved over time to fit within the circumstances of modern society, the foundation of them has been in place for centuries….

Insurance fraud is one of the real threats facing the industry. The growth of the claims culture, together with research shows consumers believe insurers are ‘fair-game’, making for a dangerous combination. The costs to manage these claims come with a risk factor; bad faith suits, medical expense, investigation expense to name but a few. The utilization of third party providers to assist in managing these claims has opened the door to the added risk of provider fraud. The cost to the industry is enormous and affects the way the public view insurance companies and their service offerings.

MetLife director of special investigations, John Sargent stated in an article "that eliminating fraud is an unachievable goal". But that hasn't stopped his company or other industry leaders from trying. "Our goal is to pay what we owe, and not a penny more or a penny less," Sargent says. "The more efficient we are at identifying and preventing fraud, the better we can be at writing business at a more competitive rate."

Insurance fraud costs Canadian policyholders over $1 billion each year. To the average Canadian citizen, that means at least 10 percent of their total insurance premiums are used to cover the cost of fraud.
http//:www.insurance-canada.ca/claims/canada/CCA1F200212

To view the full article go to

http://www.marwen.ca/files/Bridging the GAP in Escalating Insurance Claims.pdf

Gerhardt versus The City of Edmonton saw a landslide victory for the city. Backfground; a long term employee who had a history of taking unwarranted time off work sued the city for wrongful dismissal after being videotaped working for self while collecting benefits. The investigators testimony enabled the city to secure it's result. The twist; Gerhardt, had a partner - also an employee of the City and also collecting benefits on Long Term Disability. The insurer contracted a private investigator to follow the partner at the same time the Gerhardt investgation was being performed. This investigator gathered no evidence and the partner secured a "golden handshake" - all things are not equal say Marwen, the company who investigated Gerhardt. Read an article submitted by an unbiased lawyer:

To view the article go to

http://www.marwen.ca/files/LBJun2004-1.pdf

The interesting thing about this article is that it was all preventable. The first article written by Insurium briefly talks about prevention and root cause.

Look for our next post on fraud and how to prevent it