Insured Red Flags
June 15, 2015
The facts of the loss are not the only things that can indicate fraud. The behavior of the insured can also indicate that the claim or parts of it could be falsified, exaggerated, or otherwise fraudulent. The following checklist can help identify when actions or details of the insured indicate that further investigation should be conducted. Three or more of these factors indicate that the claim should be referred to investigators for further research.
____The insured has lived at his current address less than six months.
____The insured has been with his current employer less than six months.
____The insured has a previous history of losses.
____The insured cancels scheduled appointments with the adjuster for statements and/or Examination Under Oath.
____The insured is employed with an insurer.
____The insured is unusually aggressive and pressures for a quick settlement.
____The insured does not have a telephone.
____The insured is difficult to contact.
____The insured claims to be self-employed but is vague about the business and his responsibilities.
____The insured is very knowledgeable about claims processes and insurance terminology.
____The insured offers inducement for a quick settlement.
____The insured is unsolicited new, walk-in business, not referred by an existing policyholder.
____The insured's address is not consistent with his employment or income.
____The insured gives only a post office box as his address.
____The insured is unemployed or in a transient occupation.
____The insured seeks a copy of the policy before agreeing to insure.
____The insured is vague about loss details.
____The insured's report of loss is inconsistent.
____The insured has a selective memory.
____The insured has financial difficulties.
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