Fighting insurance fraud is big business throughout the nation–particularly in key states such as New Jersey and California–and keeping up with ever-evolving criminal tactics via formal training remains one of the major elements to assure success in this effort, players in the field contend.
The numbers involved are not just petty cash, as fraud cost property-casualty insurers about $29 billion in 2005, according to the Insurance Information Institute.
The industry and law enforcement got serious about preventing and prosecuting fraud in the 1990s with the establishment of fraud units in state police agencies and special investigation units in insurance companies, industry experts note.
While the initial focus was on auto insurance fraud, attention soon turned to workers' compensation, where investigations focus on employers who, in an attempt to obtain lower premiums, may misrepresent the number of workers and the functions they perform.
But no matter what area of insurance, fraud is an issue, and the more personnel are aware of what the bad guys are doing out there, the better the chances of stopping it are, fraud fighters contend.
California has led the way in spurring new insurance training with its requirement that anyone who touches a claim has to be able to stand as the first line of defense in the war against insurance fraud.
The National Insurance Crime Bureau in Des Plaines, Ill., provides training to thousands of insurance company and law enforcement personnel throughout the year.
Tom Welsh, vice president of training, said the blended approach of both classroom and Internet training has worked best in accommodating varying schedules, while at the same time providing the kind of training that can only come from face-to-face contact.
“All of them get it, but most of the fraud training is provided to the claims adjusters and investigators,” he said.
The academy conducts about 1,300 classroom sessions a year, in which special agents do in-depth training and go over local problems and suspected fraudulent activities.
“With a blended training approach, you can get the information you need quickly, but you also have the capability of having an investigator come in and do training at your place of work,” he said.
Most of the training does not provide certificates as such. But in those states that have continuing education requirements for claims adjusters, the academy provides the necessary documentation.
Fraud trainers also have to keep up with the fraudsters themselves, which means that course content must be constantly evolving.
“In five years, I wouldn't say the courses are completely different. The primary areas are still the same, but the way the fraudsters do things becomes a little more sophisticated,” he said. “There are enough changes in the MOs so the trainers have to keep up with them.”
The North American Training Group in Wellington, Fla., also provides online training for insurance company personnel throughout the nation.
Many states in the past have had fraud training requirements, acknowledged a representative for the group, Melissa Rhinehardt. “But the difference now is that many states are becoming more specific with what topics must be covered and who must receive the training,” she said.
The hot topic right now, according to Ms. Rhinehardt, is how the fraudsters use identity theft, and so a course on that topic was added.
“Traditionally, we think of identity theft as people using them just to make purchases, but people can assume a fake identity in order to qualify for group benefits, or in order to buy a policy at lower rates than perhaps their own driving record would allow,” she said.
It will be difficult to measure just how effective new requirements will be in the coming years to expand the scope of fraud training, such as in California.
“You might find a correlation between the number of referrals from claims handlers to special investigation units and the expansion of training in the future,” Ms. Rhinehardt suggested.
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