Case Study - Fraud Investigation

| Author: David Crawford [Member (F/1189)] | Filed under: Case Studies
Case Study - Fraud Investigation

A solicitor client of ours who was being instructed by an insurance provider advised us that his client was experiencing a ‘spike’ in certain claims. We were advised that there were suspicions of fraudulent claims being submitted on behalf of dubious claimants. The solicitor instructed that enquiries be made to establish how the principals obtained their clients and whether any fraud was occurring. At this stage the police weren't approached as very little could be proven and it was unlikely the police would direct significant resources to investigate the client’s suspicions.

An initial surveillance operation proved to be of little benefit as the suspects were surveillance aware and as a matter of course used counter surveillance techniques on a daily basis. It was believed they were involved in a variety of criminal activity.

We discussed the issues with the solicitor and his clients and it was deemed appropriate to progress the investigation onto the next level and engage with the suspects in a carefully controlled 'sting' operation. This tactic resulted in our operatives, who fit the demography of the average claimant, presenting a variety of claim scenarios to the suspects. Our claims were accepted as genuine by the suspects and they engaged with our operatives and processed the claims. As a result of this engagement we gathered audio and video evidence of the suspects heavily ‘coaching’ our operatives and explaining to them what should be said to verify their claims when speaking to claims handlers or solicitors.

As a result of this operation the client gained a comprehensive understanding of how the frauds were being committed and have adopted appropriate case management strategies to prevent further losses. Numerous cases have now been ‘Put to Proof’ in the Courts with a high percentage of successful outcomes for the insurer.

The insurer has noticed that the ‘spike’ of claims has significantly diminished and is confident that any future suspicious claims can be defended or quantum substantially reduced. The value of the fraudulent claims submitted run into the millions of pounds in value.

Article submitted by Full Member David Crawford (F/1189) who trades as Crawford Investigations in Darlington.
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