In today’s blog post, we will delve into a fascinating customer case study that demonstrates how Veritas’ Propensity of Fraud model helped a financial institution uncover a fraudulent policy claim. We will provide a brief overview of the case study, exploring the challenges faced by the financial institution, and highlight how Veritas played a crucial role in identifying the possibility of fraud and rejecting the false claim after investigation.
The policy in question offered maximum coverage of R100,000, with double payment for an unnatural death. Although the alleged deceased person was claimed to have passed away, inconsistencies in the claim was flagged by Veritas, which uncovered the possibility of fraudulent activity. As a result, the claim was flagged for potential fraud.
The financial institution faced challenges in identifying fraudulent activity and ensuring the integrity of their claims process. Veritas’ Propensity of Fraud model played a crucial role in addressing these challenges by uncovering the possibility of fraudulent activity in the policy claim.
An assessor from XTND conducted an investigation, successfully locating the supposedly deceased person and ultimately confirming that she was alive. This crucial discovery played a significant role in uncovering the fraudulent activity.
Additionally, forensic and SAPS records supported the investigation’s findings, as they had no records of the person’s death. This further corroborated the assessor’s discovery and strengthened the case against the fraudulent claim.
Tip-Off and Confrontation
The alleged deceased person was advised to visit the nearest financial institution branch to dispute the claim and prove that she was alive. XTND informed the financial institution of the tip-off, ensuring that they were aware of the situation.
Upon confrontation, the claimant displayed an uncooperative demeanour and refused to cooperate with the investigation. This behaviour, combined with the evidence gathered by XTND, ultimately led to the rejection of the false claim due to forged documents.
The Veritas Propensity of Fraud Model proved to be highly effective in uncovering fraudulent activity and protecting the financial institution’s assets and reputation. By leveraging the power of Veritas, the financial institution was able to identify and reject the false claim, ensuring the integrity of their claims process and maintaining their commitment to providing genuine coverage to their policyholders.
In summary, this customer case study demonstrates the value of using advanced analytics tools like the Veritas Propensity of Fraud Model in detecting and preventing fraudulent activity in the insurance industry. By staying vigilant and employing cutting-edge technology, financial institutions can protect themselves and their customers from the costly consequences of fraud.