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Investigating Fraudulent Claims, Part 2 (This article is part of an ongoing series)

By Anthony J. Golowski II
April 01, 2003

The first article in this series (Insurance Coverage Law Bulletin Volume 2, Number 1, February 2003) provided an overview of upcoming articles, and addressed the issue of fraud at the inception of an insurance claim. This second installment focuses on insurance carriers' analysis of fraudulent claims and the use of forensic experts to defend against claims. It also addresses the issue of fraudulent enhancement of otherwise valid claims.

Introduction

When a claim has been noted as containing, or potentially containing, fraudulent elements, it is usually referred to the carrier's Special Investigation Unit (SIU). A carrier's SIU is generally charged with investigating fraudulent claims, working with specially trained, outside counsel, and, where required, making referrals to the appropriate criminal, civil or administrative agencies.

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