Course Introduction

FSP 303: Insurance Fraud Investigation

  • Course Outline
  • Curriculum
  • FAQ
  • Case Studies
  • Reviews

July Batch 2024

Last Date to Register : 25th July 2024

The Insurance Fraud Investigation Online Course by SIFS India equips you with the skills to become proficient in preventing and investigating insurance fraud.

As an insurance fraud investigator, you will learn how to uncover fraudulent insurance claims, spot deceitful practices, and gather reliable evidence for legal purposes.

You will have access to pre-recorded sessions by forensic insurance fraud investigators upon enrolling in the course.

Associate Degree Program comprises of three levels: Level 1 (certificate), Level 2 (diploma), and Level 3 (Post Graduate Diploma), and the entire curriculum is divided among these levels.

A few of the topics you will learn about are the history and purpose of insurance fraud, types of insurance fraud, the role and duties of an insurance fraud investigator, gathering and examining records, policy as a contract, the insurance fraud investigation process, information gathering, legal issues associated with information sharing, surveillance methods and preparation techniques, and case-specific insurance investigations.

So enroll now to safeguard the trust and financial security of insurance providers and policyholders alike.

Course Benefits

Enrolling in this course will equip you with crucial insurance fraud detection skills. You will gain an in-depth understanding of the techniques for identifying fraudulent claims, analyzing insurance documents, and providing expert testimony. After this course, you can work with insurance companies, legal and investigative agencies, and private forensic labs and institutes to assist in fraud examination and reduce fraud losses.

Course Outcome 

Upon successfully completing this course, you will gain expertise to conduct comprehensive insurance fraud investigations, thereby exposing fraudulent insurance claims and presenting evidence admissible in court. You will become well-versed in implementing fraud detection techniques in insurance-related cases within a legal framework.

Course Highlights

- Pre-recorded sessions with practical insights about tools and software used in insurance fraud investigations

- Lectures by professionals with experience in fraud examination and insurance fraud detection

- Industry-specific and comprehensive study material and reference books

- Opportunity to join a community of insurance fraud investigators and experts

- Professional network expansion, thereby enhancing your career prospects

Payment Details:

International Student : PayPal: forensicdocument@gmail.com

Account Details for National Student

Bank Name  - ICICI BANK
Acc. Name    - SIFS INDIA PVT. LTD.
Account No. - 663505500086
Type         - Current
IFSC Code    -   ICIC0000160
Address         - ICICI Bank, H-4, Model Town -III, New Delhi - 110009

  • Level I : Insurance Fraud Investigation

    MODULE 1 – INSURANCE AND INSURANCE FRAUD

    The module covers an overview of insurance fraud, its historical roots, the role of insurance fraud investigators, both as carriers and professionals, and a comprehensive understanding of the Code of Ethics. You will also learn about the Insurance Fraud Prevention Model Act and the steps involved in the expert selection process, a crucial component in the insurance fraud investigation domain.

    MODULE 2 – TYPES OF FRAUDS

    This module introduces you to the various types of insurance fraud, providing a comprehensive overview that includes health insurance fraud, car insurance fraud, home insurance fraud, life insurance fraud, worker compensation fraud, and instances of fraud perpetrated by insurance companies. This categorization will help you gain an in-depth understanding of the techniques employed across different sectors of the insurance industry, highlighting the multifaceted nature of fraudulent activities within the insurance domain.

    MODULE 3 – ROLE AND DUTIES OF INSURANCE FRAUD INVESTIGATOR

    In this module, you will gain insights about the role and duties of an insurance fraud investigator, including locating information sources, gathering and examining records, and conducting insightful witness interviews. The module also covers the significance of meticulous witness preparation using a systematic approach. This module provides a step-by-step guide for insurance fraud investigators to help them build a robust case against fraudulent activities.

    MODULE 4 – POLICY: THE CONTRACT

    This module covers the intricacies of insurance policies for fraud investigations and begins with an introduction to the language and contractual nature of policies. It then explores first- and third-party policies, focusing on distinctions that mold the dynamics of coverage and claims. Additionally, the concept of the innocent co-insured is introduced, highlighting the complexities that may arise in insurance scenarios.

    MODULE 5 – INTERVIEW PROCESS DURING INSURANCE FRAUD INVESTIGATION

    In this module, you will learn about the process of extracting crucial information through a well-structured approach. It begins with the importance of the preliminary statement of the insured or claimant in understanding the context of the claim, various statement methods, including preparation, active listening, and maintaining control for extracting accurate and detailed information, and the methods to obtain witness statements.

  • Level II : Insurance Fraud Investigation

    MODULE 1 – INSURANCE AND INSURANCE FRAUD

    The module covers an overview of insurance fraud, its historical roots, the role of insurance fraud investigators, both as carriers and professionals, and a comprehensive understanding of the Code of Ethics. You will also learn about the Insurance Fraud Prevention Model Act and the steps involved in the expert selection process, a crucial component in the insurance fraud investigation domain.

    MODULE 2 – TYPES OF FRAUDS

    This module introduces you to the various types of insurance fraud, providing a comprehensive overview that includes health insurance fraud, car insurance fraud, home insurance fraud, life insurance fraud, worker compensation fraud, and instances of fraud perpetrated by insurance companies. This categorization will help you gain an in-depth understanding of the techniques employed across different sectors of the insurance industry, highlighting the multifaceted nature of fraudulent activities within the insurance domain.

    MODULE 3 – ROLE AND DUTIES OF INSURANCE FRAUD INVESTIGATOR

    In this module, you will gain insights about the role and duties of an insurance fraud investigator, including locating information sources, gathering and examining records, and conducting insightful witness interviews. The module also covers the significance of meticulous witness preparation using a systematic approach. This module provides a step-by-step guide for insurance fraud investigators to help them build a robust case against fraudulent activities.

    MODULE 4 – POLICY: THE CONTRACT

    This module covers the intricacies of insurance policies for fraud investigations and begins with an introduction to the language and contractual nature of policies. It then explores first- and third-party policies, focusing on distinctions that mold the dynamics of coverage and claims. Additionally, the concept of the innocent co-insured is introduced, highlighting the complexities that may arise in insurance scenarios.

    MODULE 5 – INTERVIEW PROCESS DURING INSURANCE FRAUD INVESTIGATION

    In this module, you will learn about the process of extracting crucial information through a well-structured approach. It begins with the importance of the preliminary statement of the insured or claimant in understanding the context of the claim, various statement methods, including preparation, active listening, and maintaining control for extracting accurate and detailed information, and the methods to obtain witness statements.

    MODULE 6 – INFORMATION GATHERING AND LEGAL ISSUES OF SHARING

    In this module, you will learn about various methods of information gathering and analysis, including the Immunity Reporting Act (incentivizing individuals to come forward with information related to fraud), the Public Records Act (facilitating investigators to access essential data for in-depth scrutiny), and reciprocal information exchange (exchange of insurance contracts between individuals and businesses).

    The module also covers several information gathering methods like historical website information searches, newspaper investigations, and scrutiny of city/country business and professional licensing. This adds depth to the investigative process and increases its reliability in exposing potential fraudulent activities.

  • Level III : Insurance Fraud Investigation

    MODULE 1 - INSURANCE AND INSURANCE FRAUD

    The module covers an overview of insurance fraud, its historical roots, the role of insurance fraud investigators, both as carriers and professionals, and a comprehensive understanding of the Code of Ethics. You will also learn about the Insurance Fraud Prevention Model Act and the steps involved in the expert selection process, a crucial component in the insurance fraud investigation domain.

    MODULE 2 - TYPES OF FRAUDS

    This module introduces you to the various types of insurance fraud, providing a comprehensive overview that includes health insurance fraud, car insurance fraud, home insurance fraud, life insurance fraud, worker compensation fraud, and instances of fraud perpetrated by insurance companies. This categorization will help you gain an in-depth understanding of the techniques employed across different sectors of the insurance industry, highlighting the multifaceted nature of fraudulent activities within the insurance domain.

    MODULE 3 - ROLE AND DUTIES OF INSURANCE FRAUD INVESTIGATOR

    In this module, you will gain insights about the role and duties of an insurance fraud investigator, including locating information sources, gathering and examining records, and conducting insightful witness interviews. The module also covers the significance of meticulous witness preparation using a systematic approach. This module provides a step-by-step guide for insurance fraud investigators to help them build a robust case against fraudulent activities.

    MODULE 4 - POLICY: THE CONTRACT

    This module covers the intricacies of insurance policies for fraud investigations and begins with an introduction to the language and contractual nature of policies. It then explores first- and third-party policies, focusing on distinctions that mold the dynamics of coverage and claims. Additionally, the concept of the innocent co-insured is introduced, highlighting the complexities that may arise in insurance scenarios.

    MODULE 5 - INTERVIEW PROCESS DURING INSURANCE FRAUD INVESTIGATION

    In this module, you will learn about the process of extracting crucial information through a well-structured approach. It begins with the importance of the preliminary statement of the insured or claimant in understanding the context of the claim, various statement methods, including preparation, active listening, and maintaining control for extracting accurate and detailed information, and the methods to obtain witness statements.

    MODULE 6 - INFORMATION GATHERING AND LEGAL ISSUES OF SHARING

    In this module, you will learn about various methods of information gathering and analysis, including the Immunity Reporting Act (incentivizing individuals to come forward with information related to fraud), the Public Records Act (facilitating investigators to access essential data for in-depth scrutiny), and reciprocal information exchange (exchange of insurance contracts between individuals and businesses).

    The module also covers several information gathering methods like historical website information searches, newspaper investigations, and scrutiny of city/country business and professional licensing. This adds depth to the investigative process and increases its reliability in exposing potential fraudulent activities.

    MODULE 7 - CONDUCTING SURVEILLANCE

    Surveillance means the careful monitoring of the activities of a person or a place by law enforcement officials because of a crime that has taken place or when there is a possibility of the occurrence of a crime. This module covers surveillance methodologies in insurance fraud investigations, including steps involved in their preparation, along with foot and vehicle surveillance techniques.

    The module also explores fixed and moving surveillance, night surveillance, satellite surveillance, single vehicle and two vehicle surveillance, video surveillance, tips for conducting robust surveillance, and the role of vendor management, highlighting its significance in insurance fraud surveillance operations.

    MODULE 8 - CASE-ORIENTED INSURANCE INVESTIGATION

    This module explores situation-specific insurance investigations like fraudulent disability investigations, motor vehicle accident investigations, premise accident investigations, railroad crossing investigations, and suicide investigations. You will also learn about accident reconstruction experts and the basics of fire and explosion investigations, highlighting the significance of specialized knowledge in handling such cases. The module concludes by focusing on the need for photography in insurance investigations to capture evidence and document the investigative process.

  • What steps should I follow to enroll in this course?

    To enroll, click on the “Register for Course” option available on the right side of the screen, followed by the provided instructions and payment procedure.

  • Can I pay directly to the bank account of SIFS India?

    Yes, you have the option to make a direct payment to the bank account of SIFS India;, all you have to do is write an email at education@sifs.in requesting the bank details. 

  • Which documents I have to upload at the time of enrollment?

    Academic Qualification Documents, Professional Qualification Certificates, and National ID Proof or Passport Copy are required at the time of enrollment.  

  • What if I am unable to upload my documents?

    Kindly send your necessary documents with proof of payment to admission@sifs.in.

  • How will I receive confirmation once I have completed the payment procedure?

    An Admission Confirmation email will be sent with your portal credentials once the proof of payment and application form with all the necessary documents are received at admission@sifs.in.

  • How do I login to the portal for my course?

    To login, visit the portal at the given link: https://www.sifs.in/student and enter your login credentials, i.e., your username and password shared via email. 

  • What study material access will I have after logging into the portal?

    After logging into the portal, you will have access to reading material, reference eBooks, and e-research papers.

  • Will I receive any assignments during my course duration?

    Yes, all your assignments, projects, case studies and practice tests will be assigned to you through your portal as per the level you will be enrolled in.

  • What technical prerequisites are necessary for an online course?

    You can easily access our online course on mobile / tablet devices. We highly recommend that you use your desktop or laptop and a reliable internet connection for a better view.

  • Will there be any exams after completing the course?

    Yes, there will be an online exam after completing the course.

  • Will I receive any certificates after completing the online course?

    Yes, upon successful completion of the course, you will receive a certificate and marksheet, which can be a valuable addition to your resume and may enhance your career prospects in the field.

  • Where to contact in case of any queries or technical support?

    Write to us at admission@sifs.in, call: +91-1147074263, or WhatsApp: +91-7303913002.

Maharashtra 2 Crore Insurance Fraud Case Study

This is a case of a 30-year-old man arrested by Shivaji Police, Maharashtra, who, with the help of his two friends, faked his death to make an insurance claim of Rs. 2 crore.

He submitted bogus documents to LIC claiming the death of Dinesh Taksal.

A police investigation showed accused Dinesh Taksal created fake parents to claim his dead body.

The fake parents identified a man as their son Dinesh even when the dead body’s face was badly crushed and could not be recognized.

After this, the police began to find the real identity of the person who died and also of the fake parents.

The police identified his two friends as Anil Latke and Vijay Malvade.

All the accused belong to Ahmednagar. The reinvestigation of the Ahmednagar road accident also started to determine the identity of the dead person.

Police also registered a case against Nandabai Dinesh’s mother on complaints by LIC, suspecting her involvement as well. However, she was found innocent and even helped police officials discover the truth.

This case took place in 2015 when Taksal, while purchasing a LIC policy, submitted fake income tax papers and made a wish to purchase a policy worth Rs. 8 crore.

However, upon examining the documents submitted by him, LIC issued him a policy of Rs. 2 crore only.

He paid the premium until December 2016, and a claim for his death in a road accident at Belwandi was made in March 2017.

An accidental death report was registered by the Ahmednagar police. Since the deceased's identity could not be detected, the case was closed before the Ahmednagar district court.

Soon after the case was closed, a couple claiming Taksal as their dead son appeared before the magistrate court.

This created a huge surprise among insurance company officials as to how a death claim can be made within one and a half years of a policy purchase.

The company officials began internal investigations and found that most of Taksal’s properties in Mumbai and Ahmednagar have been sold.

During investigations, it was found that his father died way back in 2012, and his mother also confirmed that her son was alive and came to meet her often.

This was how the insurance company caught the fake story created by Taksal.

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
Dr. Ranjeet Singh

Dr. Ranjeet Singh

Managing Director

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