Fraud Indicators and Red Flags in Claims
This domain tests your ability to separate suspicious claim features from innocent explanations, across motor, property, liability and life/health claims. Examiners want structured indicator reasoning and proportionate next steps.
Motor indicators
- Late notification, keys allegedly unavailable, theft without forced entry or with inconsistent alarm history.
- Staged collisions, sudden-braking crash-for-cash patterns, phantom passengers, injuries inconsistent with damage severity.
- Repair estimates far above market, duplicate invoices, pre-existing damage, repeated use of the same repairer or medical expert.
Property and liability indicators
- Theft with no forced entry, missing receipts, high-value items added shortly before the loss, alarm not set.
- Arson indicators: multiple seats of fire, accelerant traces, financial distress, pets or valuables removed.
- Slip-and-fall claims with witnesses produced late, or several claims routed through the same solicitor or claims farm.
Life and health indicators
- Non-disclosure of conditions, death shortly after inception, unusual beneficiary arrangements.
Behavioural indicators
- Pressure to settle quickly, refusal to meet, unusual correspondence, links to known fraud rings.
Worked example
A burglary claim reports no forced entry, £14,000 of jewellery added three weeks earlier, no receipts, and an alarm left unset while the insured was away. Each indicator is individually explainable; together they justify referral to a special investigation unit, proof-of-purchase checks, and lawful social media review.
Traps
- Treating indicators as proof or ignoring base rates and false positives.
- Letting bias drive the enquiry rather than the evidence.
- Failing to record why an indicator was resolved as innocent.