Fraud and Investigations

Fraud is a challenge for all insurers and the cost is significant to insurers and consumers alike.

In an insurance context, fraud can present as anything from the deliberate misrepresentation of facts to the exaggeration of a loss and the sophisticated orchestration of illegitimate claims. It can be opportunistic or premediated and is committed by both professional fraudsters and law-abiding citizens.

Fraud is a continually evolving area of insurance law and we keep abreast of these developments. We work with our clients to share and communicate relevant legal updates as we believe understanding the legal framework is a critical part of the claim investigation and fraud detection process. We know detection and deterrence go hand in hand.

We also understand the landscape, know the stakeholders and can easily identify the “red flags” in a variety of claim scenarios. We regularly work with investigators, forensic experts and law enforcement agencies.

Our team assists our insurer clients by informing the strategic direction of claim investigations, devising targeted evidence gathering solutions and providing general advice on the evidence. In addition, when needed, we are able to defend litigated claims and/or pursue recovery of fraudulent claims.

We have also developed specialised training programs for the fraud and investigations departments of our insurer clients. We believe that knowledge is key and that when partnering with our clients in this manner, significant inroads may be made to combatting insurance fraud.