Insurance fraud, may be defined as, act committed with an intent to obtain a fraudulent result from an insurance process. This may occur when a claimant attempts to obtain some benefit to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation the most common schemes include: Premium Diversion, Fee Churning, Asset Diversion, and Workers Compensation Fraud. The perpetrators in these schemes can be both insurance company employees and claimants. False insurance claims are insurance claims filed with an intent to deceive an insurance provider.
Insurance fraud has existed since the beginning of insurance as a commercial enterprise. Fraudulent claims account for a significant portion of all claims received by insurers, and cost billions of dollars annually. Types of insurance fraud are diverse, and occur in all areas of insurance. Insurance crimes also range in severity, from slightly exaggerating claims to deliberately causing accidents or damage. Fraudulent activities affect the lives of innocent people, both directly through accidental or intentional injury or damage, and indirectly as these crimes cause insurance premiums to be higher. Insurance fraud poses a significant problem, and governments and other organizations make efforts to deter such activities.
The chief objective in all insurance crimes is financial profit. Insurance contracts provide both the insured and the insurer with opportunities for exploitation and manipulation. According to the Coalition against Insurance Fraud, the causes vary, but are usually centered on greed and holes in the protections against fraud. Often, those who commit insurance fraud view it as a low-risk, well-paid enterprise. Drug dealers who have entered insurance fraud think it’s safer and more profitable than working street corners. Compared to other crimes, court sentences for insurance fraud can be lenient, so scammers may try to take advantage of the system. Though insurers try to fight fraud, some will pay suspicious claims, since settling such claims is often cheaper than legal action.
This course would offer the students to prove the mettle of their skill by learning various techniques that may be acquired to enhance their skills and career in the Insurance Fraud Investigating companies and firms.
Module- 1 An introduction to insurance fraud investigation
Insurance fraud investigation is a fraud examination that centers around fraudulent efforts to collect based on excessive or fake claims. Module will be introduce you to the introduction of insurance fraud investigation, insurance fraud investigation as a career, the profession of an insurance fraud investigator and the code of ethics.
Module- 2 Duties of insurance fraud investigator
Generally insurance investigator tries to define whether someone has filed a fake insurance claim. Duties of insurance fraud investigator module will define you the introduction of the basic identifiers, investigative theories, methodology, principles of investigative methodology, locating sources of information, public records and semi restricted records and the public semi-restricted records.
Module- 3 Insurance investigations
Today’s world, fraud is an actual and costly issue. This module insurance investigations would be introduce you to the introduction, fraudulent disability investigations, motor vehicle accident investigations, premise accidents investigations, railroad crossing investigations, suicide investigations, accident reconstruction experts and basics, fires and explosions and the importance of forensic photography.
Module - 4 Interviewing and interrogation
This module is framed to make the students understand the basic principles of interviewing, interview objectives, the interviewee’s attitude manage, different types of interview, the art of questioning, suggestions and tips, dealing with deceptive responses, client interviews, third party interviews, witness interviews, expert interviews and the fundamentals of interrogation.
Module - 5 Note taking and report writing
Note taking and report writing are the primary concerns of the investigation. It is comprising the note taking guidelines and suggestions, guidelines for good report writing and its methods and techniques.
Module - 6 Using pretexts
Usually, pretexting is using pretentious lettering to obtain information from someone, often playing on people’s normal desire to conversation. It might pretend to be somebody else, tell a white lie, or create some other dishonesty to obtain any information. Module will introduce you to the guidelines for investigation like pretexting introduction, illegal pretexts, and the guidelines for using pretexts.
Module - 7 Civil investigations
Civil matters are very crucial to open every important part of information and accurate findings. Module will introduce you to the definition of civil law, defenses against tort actions, an introduction to civil investigations, liquor liability investigations, professional malpractice investigations and the product liability investigations.
Module - 8 Surveillance
Term surveillance, is basically the monitoring of the activities of any person, or other altering information, usually of people for the purpose of manipulating, dealing, directing, or caring them. It will define you the introduction of the surveillance, principles, surveillance by foot, fixed surveillance, common carrier surveillance, vehicle surveillance, single vehicle surveillance, moving surveillance, tips for better surveillance, surveillance at night, two vehicle surveillance and video surveillance.
Module - 9 Criminal investigations
Criminal investigation looks intended for traces and evidence to define whether a crime has taken place. Whenever a crime has been committed investigator may look into the background of the suspect and may try to disclose who committed the criminality. Module comprises the general principles of criminal investigation, the burden of proof, criminal defense investigations, fundamental principles of evidence, presumptions and the burden of proof, evidence preservation and forensics and fundamentals of undercover investigations.
Module - 10 Background investigations
Background Investigation has become demanding need in the corporate sectors of today. In the current period, because of the day by day growing duplicitous tendencies and treachery, corporate sectors have started hiring investigators. Module dealing with the assets background checks, business partners background checks, pre - employment background checks, mate checks, self-defense background checks and witnesses and jury background checks.
Module - 11 Finding missing persons
Investigation agencies frequently focus on runaway children, finding kidnapped, missing, background check etc. They can also locate missing adult or old person. Missing person’s investigators are hired by ones when mysteries need solved. Module will be introduce you to the types of missing persons, the preliminary interview with your client, finding young missing persons, finding indigent and homeless missing persons and finding other types of missing persons and case studies.
Module - 12 Commercial theft investigations
Crime insurance is broadly used to define a selection of person, coverage relating to illegal activities. Every type of association is susceptible to criminal activities. Module would be introduce you to the retail theft investigations, the general principles of retail theft investigations, classification of shoplifters, recognizing a shoplifter, the methods of shoplifting and the types of employee theft.
Module - 13 Domestic investigations and court testimony
Introduction of domestic investigation, Child custody investigation, fidelity investigation and the court testimony are comprises in this module.
The evaluation process varies depending upon the course you enroll for, likewise: if you are enrolled for Certification, you will be allotted an assignment during the mid-session of the course, which you are deemed to complete within the month. Similar process is followed in Diploma. But in PG Diploma, after the completion of the assignment during the mid-sessions; a Project-work is assigned during the last quarter, which you have to complete in a month’s time.
The mode of examination will be online for the students enrolled either in online courses or in distance course. After the completion of the respective course duration, a username and password would be generated for all the enlisted students. The username and the password would be mailed to every student prior to the date allotted for the examination to be held, and accordingly they would be requested by the concerned authorities to check their mails, so that they could use the specified details in order to give their exams on our online examination portal on the allocated date and time.
Note: Every student will be given a username and password a month before the conducting of the exams for the demo-exams, so that they get to know every detail concerned with the online examination pattern.
The complete correction and evaluation takes about two weeks. After the evaluation process is finally done, the mark-sheets and certificates are posted on to the postal address of every student, but only after verifying their postal addresses as mentioned on the submitted application forms. Therefore, the students are always requested to mention their correct and complete address on their application form, in order to avoid further confusion and disappointment.
This collaborative training session is designed for online and distance students. The training would acquaint the students with practicals of Insurance Fraud Investigation, work on real cases and the digital techniques required to be an eminent and well-experienced detective.
Module structure: Insurance fraud investigation has become a very demanding service in the recent days. A person equipped with witty common sense to find out the something that seems to be hidden, is aptly fit for undergoing this course. A one month training programme has been designed to acquaint the students with basics of this course code.
Module- 1 Insurance fraud and criminal investigations
Insurance fraud investigation is a fraud examination that centers around fraudulent efforts to collect based on excessive or fake claims. Training module will be introduce you to the introduction of insurance fraud investigation, insurance fraud investigation as a career, the code of ethics. It comprises the general principles of criminal investigation, the burden of proof, criminal defense investigations, fundamental principles of evidence, presumptions and the burden of proof, evidence preservation and forensics and fundamentals of undercover investigations.
Module- 2: Skip Tracing and locating missing persons-
The summer training as announced the exercises and experiences with the full fledge training in the forensic lab. In this training module skip tracing and locating missing persons the students will be taught as how to deal with such cases in real, by sharing their experiences and by letting them familiarize with the methodology and amusing sense required to be equipped with, while facing such complicated matters.
Module-3: Surveillance and surveillance photography/videography- The submission of evidence is also of great help in aiding in investigation process. Evidences are of great values in legal processes. Therefore, the students will taught about the surveillance tactics and the way to approach.
Module-4: Commercial theft investigations- Criminals have become smarter these days and they have started using far more sophisticated methods today than ever before. Commercial clients need investigators who are well-equipped with the investigative techniques and respond to criminal activities in a shrewder manner. The students, in this topic, will be taught as how to detect and eradicate internal theft, embezzlement, and manipulation of accounts and payroll.
Module – 5: Note taking and report writing
Note taking and report writing are the primary concerns of the investigation. It is comprising the note taking guidelines and suggestions, guidelines for good report writing and its methods and techniques.
DURATION OF TRAINING
The duration scheduled for the training is one month during the summer vacations.
ADVANTAGES OF TRAINING
>> The training session specially focusses to bring together online and distance students to enhance their knowledge.
>> Training will provide you the practical knowledge and opportunities to investigate the legal and personal cases.
>> The training session of the course FSP 303 Insurance Fraud Investigation course familiarize you to brief knowledge of course in classroom assembly.
>> Online and distance students attend to plenary training session and case studies, and learn more about the Private Investigation & Detective and the related skills.
>> Upon completing this training session, you will be able to develop your potential in an investigative manner.
>> The training session will help you to develop your analytical and logical thinking capabilities.
FEE FOR TRAINING
The training would be payable for online and distance learning students. But they already being enrolled as students, therefore they can avail an add-on advantage of earning 15% scholarship on their respective course fee.
After the successful completion of one month training, a valedictory function is organised on the last day where students are distributed the certificate and a farewell treat is arranged for the students from the Organization.
Outline towards Insurance Fraud Investigation career paths
Now a days Forensic Science stands in very broad manner with multiple sub-fields. In facets of crimes and its scenario, Forensic Expert are of great importance and play a vital role in solving crimes. Insurance Fraud Investigation may aid the large insurance firms and companies in investigation of crime related to insurance affairs through a legal perspective, as reaching out to the conclusions with the help of the evidences.
In the investigation related to insurance fraud, the fundamental principle is to understand and estimate the evidentiary values of the various data and facts collected as a part of a protocolled investigative procedure.
Educational Qualification to set a career in Insurance Fraud Investigation
First level course of the Forensic Science is a Certification Programme. The advantage of this course is, any students can set their career in Insurance Fraud Investigation, and no matter they belong from any discipline like Science, Commerce or Arts. These courses are also available for the Arts and Science background graduate level students who are interested to start their career from master level programme in the respective investigating science. For those students, who are opting for their Doctorate degree can choose one of the traits for their further research work and study.
Insurance has become a vital part of our daily lives. Therefore, an in-depth theoretical and practical hand on this topic may offer incalculable opportunities to the students keen to groom and nurture their careers in the respective field.
Law students and professionals both can do Certification, Diploma Course and P.G. Diploma course offered in Forensic Science.
Sectors in Insurance Fraud Investigation
Job prospects for Insurance Fraud Investigators are in Private Sectors, Government Sectors and Law enforcement agencies. Various jobs are offered in this field of Forensic Science for those students who hold ample qualification in the related fields.
Alternate job besides Criminal Investigation is teaching with abundant opportunity to upheld one’s career by imparting education.
1. What is Insurance Fraud Investigation?
Insurance Fraud Investigation as the name signifies, deals with the application of investigative techniques in cases pertaining to insurance related frauds. Students would be made aware of the various techniques employed in deciphering such cases.
2. What is the course content of FSP 303?
The course Insurance Fraud Investigation (FSP 303) includes all about introduction to insurance, its types and the malpractices involving insurance. The students would be acquainted with the various standards one should acquire to sort out such fraud cases.
For more details click on- http://www.sifs.in/prospectus/FSP-303-insurance-fraud-investigation.pdf
3. What is the course duration of Certificate, Diploma and PG Diploma courses?
All online and distance courses are divided into three certifications i.e. Certificate course for three months, Diploma course for six months and PG Diploma for one year.
4. What qualification is required to be eligible for the above-mentioned courses?
If you are looking for Certificate and Diploma courses, you must have completed your 10+2 or appearing in any discipline from Recognized Board/ School and for PG Diploma course graduation will be required. In the admission process, self-attested mark-sheets and certificates of the previous school/college and transfer certificate along with 2 passport size photographs will be required from the student.
5. Where can I register for distance or online education courses?
We provide online application form for all online or distance students. To download application, form click on- http://www.sifs.in/application-form.pdf
6. When will I receive my study materials, books etc.?
After the completion of your admission process and payment of fee, the students enrolled for online courses will receive a username and password to access e-library within 7-10 working days through mail on their mail id which is mentioned on the application form; whereas distance education students will receive hardcopy of related course materials on the mentioned address by courier or post within 15 working days.
7. What about exams and course credits?
In the last month of your course, we will conduct your online exam. All details regarding your exam will sent to you on the mail id provided by you and the course credits differs according to course code and divided into assignment, project and exam.
For more detail please click on- www.sifs.in/ims
8. How do I get my certificate/mark-sheet, when I have completed my exams?
You will receive your mark-sheet and certificate within a month on your mentioned address by courier or post.
9. What is the difference between online and distance education? Which is the best mode of education?
Both modes of education are good. The only difference between online and distance education is distance education students will get hardcopy material related to their course code, and so the distance learning students will pay Rs. 1000 more as compared to online education students. An extra amount is charged for distance learning students, as the postal charges are included in the course fee.
10. Where do I find out what courses are being offered distance or online?
We provide all information on the website- www.sifs.in
11. Although my degree is in an unrelated field of study, I have taken quite a few science courses. Am I eligible to apply?
Yes. You are eligible for this Insurance Fraud Investigation (FSP 303), if you have completed or if you are pursuing your 10+2 or graduation in any discipline from a Recognized Board/ School/ College.
12. What is the scope and career of forensic education and related courses?
Forensic Science offers a wide range of opportunity to the students aspiring to make their careers as Forensic Scientists and Investigators. With a sense of keen observation and the ability of seeing the unseen are a few traits that would promise the aspiring students to make a colorful career in the wonderful arena of Forensic.
13. Should I pay any extra fee for examination, study materials etc.?
No. Your course fee includes Study materials, Books, Notes, I-Card, Examination Fee. You are not required to pay any extra amount, but in some cases- additional taxes / fees may apply. If you are living out of India and interested in printed notes and books, then you have to pay shipping/postal charges extra. Summer training and practical sessions will be payable for online and distance students with 15% scholarship.
14. What will I get after joining distance course?
You will get User-id and password to access e-library within 7-10 working days. Study materials, notes and books related to your course and id-card will be sent on the address mentioned by you, either by courier or post within 15 working days.
15. How can I pay my course fee by credit card in USD?
Indian Students may use Universal Currency Converter from http://www.xe.com/ucc/ to pay fee in other currencies, or International students visit this link- http://www.sifs.in/onlinefee.php to check out the fee structure. You can pay your course fee from here- http://www.sifs.org.in/payment (Students enrolled for courses having course duration more than 6 months can pay their Course Fee in maximum two instalments, but Rs. 2000 will be charged extra.)
16. Why is training important?
Training is a vital part of online and distance students. It is intended to provide students with the opportunity to place theories into practicals. It is also very helpful to develop their skills that support professional life by preparing and encouraging them to apply their abilities and knowledge acquired through study in a work later on. So, even before the students completed their course they are trained to be job-ready, therefore increasing the student’s employment prospects.
17. What is the best route to prepare for a career as a forensic insurance fraud investigator?
SIFS INDIA provides professional course Insurance Fraud Investigation (FSP 303) to acquire knowledge from the basics. The course interest features the rising of such insurance related frauds in the current scenario. Subject offers the opportunity to grow your career in many sub disciples.
18. I am interested in a career in this field. Where do I start?
In order to initiate a career into this field, you should have a zeal and urge to unveil the veiled. A certificate, diploma and PG diploma course would help you groom your knowledge theoretically as well as practically, thereby ensuring a safe and secure career.
19. Where will I work?
You may avail opportunities as an Insurance Fraud Investigator in various Central as well as State governing bodies. You can also practice as a Private Fraud Examiner and present yourself in any Indian Court of Law as an Expert Witness under Section 45 of Indian Evidence Act.
20. What are the other specialized forensic science careers can be found outside the crime laboratory?
Other than working in the Crime Laboratory, you can also be appointed as a Crime Scene Investigator in Police Stations or you can also be appointed as an Investigator for the Mobile Forensic Laboratory.
Policy-holder forges documents in the course of making a valid claim
Mr. H was a self-employed plumber. In January, his home was burgled and he made a claim under his home insurance policy, which the firm duly paid. In May, his van was broken into and a number of personal possessions were stolen, including the tools he used for his work. He made another claim to the firm under the personal possessions section of his home contents policy.
During the course of its enquiries, the firm’s loss adjusters insisted that Mr. H substantiate all his losses with original purchase receipts. Mr. H was unable to find all the receipts, so he asked a friend to fake one for him.
When the firm discovered the forged receipt, it "avoided" the policy – in other words, cancelled it from the start. The firm not only refused to pay for the items stolen from the van, it also tried to recover the money it had previously paid out to Mr. H for his earlier burglary claim. After complaining unsuccessfully to the firm, Mr. H came to us.
The firm accepted that the theft from the van was genuine. Mr. H had been foolish to obtain a forged receipt but he was not dishonestly trying to obtain something to which he was not entitled. The loss adjusters had, in fact, been rather overzealous in insisting on strict proof of purchase for all the items stolen.
On applying the rationale of "The Mercandian Continent" case (reported in  Volume 2 of the Lloyd’s Law reports at page 563) which concerned the principle of "utmost good faith". Ultimately, the case held that insurers should only be able to "avoid" a policy for fraud where the insurer’s ultimate liability was affected, or when the fraud was so serious it enabled the insurer to repudiate the policy for fundamental breach of contract.
Following this rationale, it was concluded that the fair and reasonable solution was for the insurer to reinstate the policy and pay the claim. In any event, it was unlikely that the firm’s ultimate liability would be affected by the fraud, as Mr. H’s work tools were specifically excluded from the home policy. Home policies often exclude cover for contents or possessions that are for business rather than personal use.
It was also pointed out to the firm that even if Mr. H had been guilty of fraud, it would only have been entitled to "forfeit" the policy from the date of the current claim, leaving the earlier burglary claim intact. It was not entitled to recover previous payments for valid claims.
All these courses are Online / Distance mode. Each student can access their course module by login our online study portal i.e.
Apart from above course details, there are some additional details of this course. More details can be get by clicking here such as-
1. Eligibility for the Admission
2. Admission Procedure
3. Examination Pattern
4. Grading System in Examination
5. Course Fee and Concession
6. Types of Certificates
7. Study Materials
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