Meet the CSIs of Insurance Fraud

Insurance fraud costs customers $80 billion a year. Find out what we’re doing about it … and how you can help.

It may not be as dramatic a backdrop as Miami, New York, or Las Vegas, but insurance has more than its fair share of shadowy characters and intrigue. And just like the TV show, it also has investigators who are trained to solve crimes by examining the evidence. Though the people on this team might fly under the radar, they’re an essential part of the insurance industry. Of course we’re talking about the Special Investigations Unit (SIU).

SIU investigates questionable activity and refers suspected cases of insurance fraud to law enforcement agencies.

We chatted with Robert Cline, Director of SIU at Esurance, and here’s what he had to say about the work he and his team do.

Insurance fraud affects everyone

Ever wonder if you could help fight insurance fraud? Well, you can! Everyone who pays an insurance premium has a vested interest in fighting insurance fraud and can help.

The National Insurance Crime Bureau (NICB) estimates that $80 billion a year is stolen from policyholders. This is done by both individuals and organized fraud rings that specifically target insurance companies and individual policyholders.

In one recent state survey, it’s estimated that $50 from every auto premium in that state was used to pay for medical fraud. Those are your hard-earned dollars being stolen by fraudsters.

Insurance fraud takes many forms but can be generally defined by 2 types: opportunistic fraud and organized fraud. Opportunistic fraud usually takes the form of a legitimate claim or incident that’s exaggerated or embellished beyond the actual facts of the loss. An example would be filing a claim for an injury that occurred prior to the accident.

Organized fraud, on the other hand, is an actual scheme usually associated with criminal organizations. These scammers look for opportunities to purchase bogus policies and then stage accidents or other intentional events to get the claim payout.

How to fight insurance fraud

Esurance, like most insurance companies, maintains a well-staffed Special Investigation Unit. The role of the SIU is to detect and investigate attempts to defraud Esurance. In turn, this protects customers from paying higher premiums due to fraudulent payouts.

Our SIU uses state-of-the-art analytics and investigative techniques to ferret out fraud and avoid paying bogus claims. We also work closely with law enforcement and the NICB to prosecute offenders whenever possible.

So how can you help?

First, be vigilant. If you see or hear of anyone attempting to commit insurance fraud, or believe you’ve been the victim of fraud, report it. The Esurance SIU receives valuable tips through our dedicated email address, fightfraud@esurance.com. You can contact us regardless of which insurance company is involved, and we’ll make sure the information gets to the right place for review. You can also report the matter to the NICB.

Second, learn more about insurance fraud so you know how to spot it. One excellent resource is the Coalition Against Insurance Fraud. Their website is packed with easy-to-understand articles about insurance fraud schemes and how to recognize them.

Look for our interview with the manager of SIU’s fire and theft unit tomorrow!  

About Robert Cline

With nearly 20 years of SIU experience under his belt, Robert has a keen eye for insurance fraud. Prior to lending his skills to the insurance industry, Robert served as a special agent with the Army Criminal Investigations Command. He also spent several years as a reserve deputy in the Orange County Sheriff’s Department in Florida. Though he’s based out of our Tampa office, he directs the special investigations unit for all Esurance offices.

Related links

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