Adjusting Suspicious or Fraudulent Fire Claims

Overview

Many insurance fraud cases go undetected because insurers do not even realize that they have been defrauded. Even when suspicions are raised, claims personnel may be too busy to get involved, or they may simply be unwilling to deal with the repercussions and expenses of pursuing a possible fraud. Despite clear evidence that the claim is fraudulent, many such claims are paid because it costs more to successfully deny a claim than to pay it. These are among the reasons why insurance fraud is so widely practiced.

This course is built around a number of short stories describing suspicious property claims, many of which involve arson or other forms of property insurance fraud. Each of the stories is based in fact. It examines the nature of insurance fraud, reviews the process of handling property claims, presents some of the basic principles involved in investigating property claims and describes the red flags that may be raised when following the claims process and investigating property claims and those that may point to arson and arson fires. The course reviews disaster fraud—fraudulent claims that could ensue from a natural or man-made disaster. Also covered are ethical issues involved in handling questionable or suspicious claims.

Learning Objectives

Upon completion, students will be able to:

  • explain the nature of insurance fraud and the importance of fighting it
  • recognize the attributes of ethical and unethical claims activity
  • explain the relevance of insurable interests and mortgage clauses in adjusting property claims, especially those of a suspicious nature
  • recognize red flags that suggest a property claim is suspicious and may be fraudulent

Designed For

P&C producers, brokers, adjusters, risk managers and professionals interested in the prevention, detection and deterrence of fraud

International Risk Management Institute, Inc. (IRMI) is the premier provider of risk and insurance continuing education and reference publications, and is considered the ultimate authority by leading insurance practitioners. Written by industry experts, IRMI courses provide the most up-to-date, practical and reliable information possible.
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