CIFI case studies
CIFI · Put your knowledge to work in context.
The Certified Insurance Fraud Investigator (CIFI) is a credential from the International Association of Special Investigation Units (IASIU) for professionals whose work is to detect, investigate, and deter insurance fraud. IASIU describes CIFI as an accrediting process with a high standard for admission and testing: candidates document qualifying education and experience, adhere to the association's Code of Ethics, and demonstrate competency through mandatory continuing professional education. The CIFI case studies are 5 cases and about 3,545 words.
1The 21-Day Water Loss With a Missing Weekend
On March 3 a homeowners insured reports water damage discovered that morning: 47,000 for flooring, drywall and a finished basement. The policy incepted February 10 - 21 days earlier - with a 5,000 water-damage sublimit and a 30-day waiting period for water losses that the agent says was never explained.
728 words, about 4 min2The Kayak Video and the Pending Statement
A 44-year-old warehouse associate files a workers' compensation claim alleging a lumbar strain from lifting a tote on January 12. The treating physician restricts him to no lifting over 10 pounds.
723 words, about 4 min3Five Slips at the Same Strip Mall
A commercial lines agency places 62% of its small-retail book through one broker. Over 18 months, five slip-and-fall claims arise at the same 12-unit strip mall, all against different tenants insured by the same carrier.
680 words, about 3 min4The Duplicate Invoice and the Closing Bonus
A property adjuster reviewing a 61,400 fire claim finds a 2,300 vendor invoice submitted twice - once in the contents schedule and once inside the contractor's estimate. The vendor is a restoration firm the insured's cousin manages.
692 words, about 3 min5Two Passengers, One Clinic, and a Bad-Faith Complaint
A two-vehicle collision generates bodily injury claims from a driver and two passengers, each demanding 28,000 against a 30,000 per-person / 60,000 per-occurrence policy. All three treated at the same clinic within 48 hours; the clinic's bills total 39,000 for soft-tissue injuries.
722 words, about 4 min