IAI SP6 study plan

Define at least 20 core fraud terms (e.g. fraud, dishonesty, moral hazard, indemnity abuse, opportunistic vs organised fraud) in your own words and map each to a real insurance scenario

Classify the main fraud typologies by line of business: application/underwriting fraud, claims fraud (exaggeration, fabrication, staged incidents), intermediary/agent fraud, internal staff fraud and asset misappropriation

Summarise published estimates of fraud scale (proportion of claims, cost per policyholder, detection rates) and note the source, year and method behind each figure so you can quote them with caveats

Outline the legal and regulatory architecture: relevant fraud offences, insurance contract law duties, FCA/regulator expectations, data protection and money-laundering interfaces

Build a one-page diagram linking typology to the red flags, controls and legal provisions that address it

Explain each relevant criminal offence element by element (actus reus, mens rea) and state what evidence would be needed to support it

Trace the civil consequences of fraudulent claims and non-disclosure, including remedies available to insurers and the policyholder's position

Identify the regulator's rules and principles that bear on fraud management and describe how they are enforced

Map data-protection and privacy obligations onto investigation activity, including lawful basis, subject access and retention

Draft a compliance checklist an insurer could run before launching a fraud investigation

Catalogue at least 25 claims red flags across motor, property, liability, life/health and travel, and explain the reasoning behind each flag

Distinguish weak indicators from strong indicators and describe how combinations of flags raise suspicion

List underwriting red flags at proposal, at mid-term adjustment and at renewal, including non-disclosure patterns and intermediary behaviour

Design a triage scoring approach that ranks referrals by likelihood and value at risk

Test your flag lists against three anonymised-style scenarios you construct yourself and justify the referral decision

Plan an investigation end to end: scoping, terms of reference, hypothesis setting, evidence plan, resourcing and closure

Apply evidence-handling standards: continuity, integrity, contemporaneous notes, secure storage and disclosure

Select appropriate investigative techniques (open-source checks, database and registry searches, surveillance considerations, forensic accounting, medical or expert review) and state when each is proportionate

Describe how to instruct and manage external investigators and experts, including scope and reporting expectations

Explain the rules on legally privileged material and on evidence obtained improperly

Prepare an interview plan: objectives, topic sequence, question types, anticipated accounts and closing

Distinguish investigative interviewing from accusation and explain why cognitive and free-recall approaches outperform leading questions

Draft a compliant witness statement or record of interview that is accurate, attributable and admissible in the relevant forum

Identify the legal and ethical limits on interviewing, including cautioning, right to representation and vulnerable persons

Practise handling denials, inconsistencies and silence, and document how you would respond

Build a fraud risk register for an insurer: identify, assess likelihood and impact, and assign owners and treatments

Design a three-lines-of-defence control set covering prevention, detection and response, and specify the evidence each control should generate

Explain the components of a fraud risk management framework, including governance, culture, training, whistleblowing and performance measurement

Describe how analytics supports detection: rule-based triggers, anomaly detection, network/link analysis, text mining and model governance

Evaluate the limitations of analytics, including false positives, bias, explainability and data quality

Apply the relevant ethical and professional standards to five constructed dilemmas and justify the chosen course of action

Explain the duties of confidentiality, objectivity, competence and integrity as they apply to a fraud investigator

Identify conflicts of interest and describe how to manage or disclose them

Distinguish lawful, proportionate investigation from conduct that could amount to harassment, discrimination or unlawful detriment

Revisit the legal framework and correct any errors found in your week 2 checklist

Consolidate all domains into a one-page summary map linking terminology, law, indicators, investigation, controls and ethics

Complete two timed mock papers under exam conditions and mark them against the syllabus weightings

Re-drill the 20 weakest recall points identified from the mocks until each is answered correctly twice

Rehearse concise written answers that cite a standard, a control and a piece of evidence in each response

Finalise a personal exam-day plan covering time allocation per domain weighting and question-selection tactics