SOCP releases advice on spotting fraudulent claims

Claims professionals have been advised how to approach distinguishing between fraud and the misinterpretation of policies. In accordance with the FCA’s definition of insurance fraud being: “when someone invents or exaggerates a claim or does not tell the truth in order to obtain cheaper cover", the Society of Claims Professionals (SOCP) has released a good practice guide to spotting fraud.

The guide contains four key recommendations to avoid conflating attempted fraud with a misunderstanding of cover.

It encourages claims handlers to take the time to build a full picture for every claim, one which considers the specific circumstances, so as to treat clients fairly.
According to the guide, this requires an allowance for the possibility that a claimant has misinterpreted their cover.

The guide states that unless there is sufficient evidence to the contrary, a claims handler should approach with the mindset of wanting to retain the customer once their claim has been properly managed.

Claims handlers are advised to treat the customer fairly; maintain high quality data; understand the fundamental dishonesty rules; and keep up to date with new types of fraud.

Jeremy Trott, non-executive director of the Society of Claims Professionals, said: “It is important to note that, according to statistics from the Association of British Insurers, more than 112,000 cases of attempted claims fraud were detected in 2017 worth nearly £1.3 billion [$1.6 billion]

“However, while fraud is still a timely and costly drain on the insurance sector, claims should still be considered carefully so that, not only fraud is recognised where it genuinely occurs, but also that clients have access to protection when it is warranted.”

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