Course Introduction

FSP 303 : Insurance Fraud Investigation

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  • Curriculum
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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.

  • Level I : Insurance Fraud Investigation

    MODULE 1 – INSURANCE AND INSURANCE FRAUD

    Insurance fraud investigation is a fraud examination that centers around fraudulent efforts to collect based on excessive or fake claims. Module will 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 – TYPES OF FRAUDS

    Fraud is an act of deception, an intentional suppression, omission or misrepresentation of truth done for the unlawful or unfair gain. This module will introduce you to the types of frauds, types of insurance and insurance fraud such as health insurance fraud, car insurance fraud, home insurance fraud, life insurance fraud, worker compensation fraud and fraud by insurance company.

    MODULE 3 – ROLE AND 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 4 – POLICY: THE CONTRACT

    Through this module, students will enrich their knowledge about introduction of the policy and its importance. The module also covers information about the policy as a contract, first and third party policy and innocent Co-insured.

    MODULE 5 – INTERVIEW PROCESS DURING INSURANCE FRAUD INVESTIGATION

    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 and expert interviews.

  • Level II : Insurance Fraud Investigation

    MODULE 1 – INSURANCE AND INSURANCE FRAUD

    Insurance fraud investigation is a fraud examination that centers around fraudulent efforts to collect based on excessive or fake claims. Module will 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 – TYPES OF FRAUDS

    Fraud is an act of deception, an intentional suppression, omission or misrepresentation of truth done for the unlawful or unfair gain. This module will introduce you to the types of frauds, types of insurance and insurance fraud such as health insurance fraud, car insurance fraud, home insurance fraud, life insurance fraud, worker compensation fraud and fraud by insurance company.

    MODULE 3 – ROLE AND 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 4 – POLICY: THE CONTRACT

    Through this module, students will enrich their knowledge about introduction of the policy and its importance. The module also covers information about the policy as a contract, first and third party policy and innocent Co-insured.

    MODULE 5 – INTERVIEW PROCESS DURING INSURANCE FRAUD INVESTIGATION

    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 and expert interviews.

    MODULE 6 – INFORMATION GATHERING AND LEGAL ISSUES OF SHARING

    Note taking and report writing are the primary concerns of the investigation. This module will enrich the knowledge about the immunity reporting acts, public records act, reciprocal information exchange and information gathering. The information gathering helps the person and the organization to accept complicated tasks that would otherwise be enormously. The module information gathering and legal issues of sharing also defines the information of historical websites, newspaper searches, city/country business licensing and professional licensing.

  • Level III : Insurance Fraud Investigation

    MODULE 1 – INSURANCE AND INSURANCE FRAUD

    Insurance fraud investigation is a fraud examination that centers around fraudulent efforts to collect based on excessive or fake claims. Module will 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 – TYPES OF FRAUDS

    Fraud is an act of deception, an intentional suppression, omission or misrepresentation of truth done for the unlawful or unfair gain. This module will introduce you to the types of frauds, types of insurance and insurance fraud such as health insurance fraud, car insurance fraud, home insurance fraud, life insurance fraud, worker compensation fraud and fraud by insurance company.

    MODULE 3 – ROLE AND 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 4 – POLICY: THE CONTRACT

    Through this module, students will enrich their knowledge about introduction of the policy and its importance. The module also covers information about the policy as a contract, first and third party policy and innocent Co-insured.

    MODULE 5 – INTERVIEW PROCESS DURING INSURANCE FRAUD INVESTIGATION

    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 and expert interviews.

    MODULE 6 – INFORMATION GATHERING AND LEGAL ISSUES OF SHARING

    Note taking and report writing are the primary concerns of the investigation. This module will enrich the knowledge about the immunity reporting acts, public records act, reciprocal information exchange and information gathering. The information gathering helps the person and the organization to accept complicated tasks that would otherwise be enormously. The module information gathering and legal issues of sharing also defines the information of historical websites, newspaper searches, city/country business licensing and professional licensing.

    MODULE 7 – CONDUCTING 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 8 – CASE-ORIENTED INSURANCE INVESTIGATION

    Present module gives the information about the insurance investigation from different types of cases such as Fraudulent disability investigations, motor vehicle accident investigation, premise accident investigations, rail road crossing investigations, suicide investigation,  accident reconstruction experts and basics. This module also encompasses with the fire and explosion investigation and significance of photography in insurance investigation.

  • What is Insurance Fraud Investigation?

    Insurance Fraud Investigation as the name signifies deals with the application of investigative techniques in cases about insurance-related frauds. Learners would be made aware of the various techniques employed in deciphering such cases.

  • How can I become an Insurance Fraud Investigator?

    Insurance fraud is being investigated with keen observation and intellect. Learners through the course would learn the expert views and techniques to build an Expert view in themselves and prosper in the same.  

  • What are the responsibilities of an Insurance Fraud Investigator?

    The insurance investigator tries to define a fake insurance claim. The duties of the insurance fraud investigator are to identify, investigate, methodize, locate information as per the records, and opine for the client in case of fake or true insurance claim. 

  • What are the scope and the opportunistic aspects of the course?

    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.

  • Where can I contact in case of any queries?

    You can write to us at education@sifs.in or call us at +91-1147074263 or WhatsApp us +91-7303913002 or +91-7303913003.


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 [2001] 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.

Akhila Maria Joseph

5

The course was very helpful as i am pursuing a degree in forensic science.The instructors were very helpful and innovative. Continuous evaluation is the key point. 

Dr. Anuj Kumar

5

Very interesting & Knowledgeable online course by SIFS. Really appreciate the efforts and quality education provided. 

Anamta Usmani

4

Had an amazing experience. Content and evaluation were fun and very knowledgeable.

Varun Vevek

5

Since best many online courses and webinar has come up for providing knowledge to students but this course of forensic accounting by SIFS India has been the only one I have seen so far that provides the best experience and tests our knowledge even though it's through virtual platform. Thank you SIFS India.

 

Instructors

Afreen Tarannum

Afreen Tarannum

Senior Scientific Officer

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