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By Claudia Ciolfi
Senior Communications Specialist
Maryland Injured Workers' Insurance Fund
The Injured Workers' Insurance Fund makes fighting claimant fraud a companywide initiative
Although IWIF has an experienced Special Investigations Unit—comprised of 11 fraud investigators, two collectors and a support person—it instructs all employees to sound the alarm when claimant fraud is suspected. Director of Fraud Operations Jerry Landsman encourages open communication between his fraud investigators and other company employees who work in key departments such as Claims, Legal, Underwriting, Loss Control, and Customer Service.
"It's important for employees in other areas of the company to know the indicators of claimant fraud," says Landsman. "Knowing when a claim warrants a closer look can help snuff out fraud before it spirals out of control. We encourage employees, especially in claims, to look for certain types of activities, ask questions and report their suspicions to IWIF's Special Investigations Unit. At IWIF, preventing fraud is everybody's responsibility."
Landsman recommends several approaches to teach company employees about fraud:
•Hosting fraud awareness training sessions.
At IWIF, small groups of employees from varied disciplines learn from in-house fraud investigators what defines fraud, the types of insurance fraud that impact workers' compensation, how much fraud costs the industry and company, and how surveillance video can be used to support a case.
•Encouraging fraud investigators to form alliances.
Develop working relationships and direct lines of communication with employees who communicate with claimants and policyholders.
•Writing brief articles for your company's newsletter.
Ask the editor to report on fraud successes and educational efforts. Landsman says spotlighting fraud successes also gives his employees a chance to be recognized for their hard work.
•Publishing media releases.
Send factual, newsworthy media releases to business and trade publications. Let the outside world and your company's customers know about the vigilant efforts put forth by your organization to fight insurance fraud. Business owners and insurance agents want to read about your company's fraud successes. Furthermore, potential fraudsters who read your media releases might reconsider committing fraud.
•Furnishing flyers and posting posters.
Distribute fraud tip sheets and flyers to company employees, and display posters in key departments instructing employees to report their suspicions to the organization's fraud department using the fraud hotline number, email or other reporting medium.
•Establishing a recognition program.
Reward employees who report suspicious activity or fraudulent behavior—especially if their tip leads to a conviction or financial recovery.
•Asking for feedback.
Ask supported departments for feedback to identify what works well and what needs improvement. "One way to gain valuable feedback is to issue critique forms at the conclusion of each case to company employees who participated in the investigation," says Landsman. Remember, the goal is to work together to stop fraud. If one link in the chain of communication is broken, the entire effort is jeopardized.
Preventing insurance fraud remains difficult. Teaching your company's employees to look for indicators of claimant fraud, however, can help stop fraud before it spirals out of control.
IWIF scorecard
Claimant, policyholder fraud |
2004 through
2nd qtr |
2003
year-end |
Individual prosecution/
administrative action referrals |
14 |
23 |
Hard dollar recovery |
$1.8 million |
$3.1 million |
Soft dollar claim reserve reductions |
$9.6 million |
$15.2 million |
Author Claudia Ciolfi can be reached at (410) 494-2193 or cciolfi@iwif.com.
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