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How predictive modeling is flagging fraudulent claims

It can be a balancing act to identify potentially fraudulent claims and still provide superior customer service for justified claims, a handful of factors can ensure success.

By Donald Siegrist | Updated on January 11, 2016

A rather typical business story became a head-scratcher of a Workers’ Comp claim — and an illustration of the power of predictive modeling — when a seemingly “normal” claim was flagged for potential fraud.

A person traveling for business stayed in a hotel, as many people do when they travel, but with a twist. He filed a Workers’ Compensation claim for supposedly suffering an injury after falling off a chair in his room. According to the claimant, he could no longer work, but he didn’t expect that a predictive modeling tool would flag his case based on his occupation and other factors, bringing it to the attention of the insurer’s Special Investigations Unit (SIU).

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