While a checklist for a particular type of fraud or claim filer may be useful in some claims, many times there will be multiple indicators over several circumstances. This checklist combines all the separately listed checklists into one, making it easy to highlight multiple indicators without having to use multiple checklists.

Facts of Loss

____Witness version does not agree with claim as presented.

____Presence of an overly enthusiastic witness at the scene of the incident.

____No police report.

____All injuries are subjective.

____CPT codes appear inflated or "up-coded".

____Losses occur just after coverage takes effect.

____Losses occur just before coverage ceases.

____Losses occur just after coverage limits have been increased.

____Losses include a large amount of cash.

____Commercial losses include old or non-saleable inventory.

____Building is in deteriorating condition.

____Building is located in a deteriorating neighborhood.

____Fire scene investigation suggests property or contents were heavily over-insured.

____Fire scene investigation reveals no remains of non-combustible items of scheduled property.

____Fire scene investigation reveals no remains of expensive items used to justify an increase of limits.

____Fire occurs at night.

____Fire occurs after 11 p.m.

____Commercial fire occurs on holiday, weekend or when business is closed.

____Fire alarm fails to work.

____Sprinkler system fails to work at time of loss.

____Insured over-documents losses.

Timing Issues

____Shortly after the issuance of the policy.

____Shortly after the limits of the policy are increased.

____In an insured's first insurance.

____Shortly before the expiration of a policy.

____Within days of a notice of cancellation being served.

____On a policy acquired from an agent far from the insured's home or business.

Arson Indicators

____More than one mortgage.

____Late payments.

____Divorce.

____Prior claims.

____Multiple claims.

____Problems affecting title to the property.

____Over-insurance.

____An increase in insurance coverage right before the claim.

____Recent cancellations of insurance held with prior insurers.

____Liens.

____Threats of foreclosure on the property.

____Lawsuits.

____Recent job transfers.

Insured Red Flags

____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 process 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 only gives 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.

Claimant Red Flags

____Retains or is represented by counsel on the day of the loss/immediately after claim is reported.

____Represented by a public adjuster on the day of the loss.

____Wants a settlement approved quickly.

____Does not want the claim to go to a supervisor, regional office, or claims committee for authority.

____Is exceedingly cooperative and undemanding.

____Is exceedingly demanding and threatens a bad faith suit from the date of first contact.

____Demands a proof of loss form at the initial meeting.

____Is familiar with insurance claims terminology.

____Asks for the claims manager by name.

____Is familiar with the adjuster's authority limits, and wants to settle for a sum within those limits.

____Handles all business in person (thus avoiding mail and potential prosecution for violation of federal mail fraud statutes).

____Provides an address that is a post office box, mail drop, or hotel.

____Reduces the demand for settlement when it is suggested by the adjuster that he or she file suit.

____Has a history of multiple, similar claims.

____Has a history of more than two lawsuits.

____Is recently separated or divorced (indicating a possible financial strain).

____Was recently laid off a job, has a spotty work history, or extended period of unemployment.

____Has a history of gambling, alcohol, or drug abuse.

____Insured is eager to accept blame for an accident.

____Claimant and insured know each other.

____Claimant and insured are from the same family.

____Claimant and insured have the same address.

____One or more parties present damages that are inconsistent with the facts of the loss.

____Claimant's lost earnings statement is handwritten or typed on blank paper rather than business letterhead.

____Claimant has multiple insurance claims.

____Several or all claimants treated at same clinic on same day.

____Vehicle was purchased for cash.

____Claimant has no proof of ownership of vehicle.

____Vehicle recovered surgically stripped.

Professional Red Flags

____Attorney reports claim to insurance company.

____Attorney is known as a lawyer who handles suspicious claims.

____Attorney's office is run by an administrator.

____Attorney is rarely or never seen at the office.

____Attorney lien or representation letter dated the day incident was reported.

____High incidence of claims from attorney who recently passed the bar exam.

____Attorney and body shop frequently appear linked.

____All vehicles in reported loss are taken to the same body shop.

____Clinic may have continued billing or treatment irregularities.

____Clinic billing is done by an outside service.

____Clinic treats several or all of the claimants on same day.

____Physician immediately refers claimant for a wide variety of tests not related to original claim.

____Contractor has inadequate equipment to perform job.

____Contractor arrives at loss site without being solicited.

____Contractor offers cash incentives to get the job.

____Contractor is not bonded or insured.