Training the Global Life and/or Health Fraud Investigator as well as the Travel Claims Investigator and engaging the insurers’ Special Investigators and Claims Examiners!
This is the section in which we share specific knowledge or information on how the local Investigator can become a better professional by effectively investigating life, health and travel insurance claims and reporting on the findings. Effective investigation is one in which the Investigator covers every gamut of inquiries expected and conveys the findings in such a concise and succinct form that it communicates the salient aspects to the reader. The reader may be the Claims Examiner in the insurance office whether in the country or overseas in Africa, North/South America, Europe or Asia. The report should also be read and understood by the attorneys and the judge adjudicating a fraudulent claim litigated in the court.
Further, we intend in this column to engage our hordes of clients around the world by sharing our investigative experience with them.
TRAINING / No. 7 GLOBAL - Health Insurance and Medical Expenses Claims
The Venezuela Challenge: Dual foreign exchange controls (up to
January 29, 2018)
VENEZUELA / GLOBAL – In the same vein, if the Claims Examiners in the United States are presented a bill indicating medical charges, BsF1,000,000.00, incurred say on September 6, 2017, then the amount payable is BsF1,000,000.00 divided by the erstwhile DICOM rate of BsF2640.00 applicable on that date. That equals US$378.79. If the bill is BsF2,000,000.00, the US dollar equivalent sum would be US$757.58. If the Claims Examiners unwittingly apply the wrong rate, the DIPRO rate, which is same as the online rate, they would be faced with the equivalent sums of US$100,000.00 and US$200,000.00 respectively.
Training I No. 6 GLOBAL — Life Insurance and Accidental Death Claims Interviewing the family is a sine qua non to uncovering the fraud!
GLOBAL - Life Insurance & Accidental Death Claims
Interviewing the family is a sine qua non to uncovering the fraud!
The trend these days with life insurers’ Claims Examiners and Special Investigators is to instruct field Investigators not to conduct inquiries with the claimant’s family members. Often, the insurers are inundated with requests by claimants that they do not want their family to be contacted by the Investigators. The excuse they readily offer is that they do not want their family to know there was a life insurance on the deceased family member!
Training I No. 1 GLOBAL — Health Insurance and Medical Expenses Claims Always speak with the No. 1 officer!
GLOBAL - The Investigator should make it a point on attending the place of inquiry, whether at a medical facility such as a clinic or hospital or the paramedical facility such as a laboratory, pharmacy, X-Ray center or in any other independent radiological center, to seek out the No. 1 officer at the facility rather than the person whose name appeared in the claim documents. The reason for this is that the official whose name appeared in the document may have colluded with the claimant in making the claim and thus communicating first with that individual may not augur well for you to obtain the facts of the case.