Five Tips for Handling Catastrophe Claims Fraud

By Carlos Martins  |  May 1, 2013

With hurricane season right around the corner, memories of Superstorm Sandy remain fresh. Forecasts for storm activity are starting to appear, as they do every April, and it looks as though this year may be above average. According to Artemis, the Tropical Storm Risk consortium expects 15 named tropical storms, with 8 becoming hurricanes and 3 reaching at least Category 3. Meteorological consulting firm Weatherbell anticipates 16 named storms, with 12 becoming hurricanes and 5 reaching at least Category 3.

It’s time to start thinking about catastrophe claims — and catastrophe claims fraud.

We’ve heard from many ISO ClaimSearch® users since Sandy struck, and many have had questions about how to use their fraud detection tools more effectively in the wake of a catastrophe event. Here are a few tips to help you get started:

1. Report all claims involving catastrophe losses (or any other weather-related claims) to ISO ClaimSearch. That will help you identify undisclosed duplicate insurance, unrepaired previous damage, and questionable claim activity by insureds, contractors, and public adjusters.

2. Use the appropriate catastrophe serial number from Property Claim Services® (PCS®) when you submit your claims to ISO ClaimSearch. That will make it much easier for you to track and manage catastrophe claims activity, identify trends, and deploy your adjusters more effectively.

3. Report catastrophe claims to ISO ClaimSearch and designate as such. You’ll be able to manage catastrophe and noncatastrophe claims, run claims inquiry queries on catastrophe claims, and aggregate catastrophe claims for analysis.

4. Use the Weather Forensic Reports in Decision Net® to conduct claims analysis and investigations and detect fraud. Specific tools include:

  • severe wind reports to secure local wind speed readings and on-site observations
  • weather-related claims reports to identify whether your claimants’ severe weather claims are within the pattern of losses of other carriers reporting claims to ISO ClaimSearch

5. Manage investigations with SIU Case Manager to make sure cases don’t fall through the cracks. The tool integrates with ISO ClaimSearch, and it will notify you if another carrier opens a second claim (in ISO ClaimSearch) regarding the same entity of interest. Further, you can group multiple claim-focused cases together to help investigators better manage their catastrophe claims.

The risk of impropriety doesn’t stop when the wind slows down. Use NetMap for ClaimSearch to watch proactively for unscrupulous contractors and other service providers that have histories of suspicious activity.

Carlos Martins

Carlos Martins, SCLA is Vice President and General Manager of ISO ClaimSearch Solutions. Carlos leads the operations of ISO ClaimSearch®, the property/casualty industry’s premier and only “all claims” database with over 1.2 billion claim records and market participation of more than 90 percent of the property/casualty insurance industry. Carlos is also responsible for the surrounding ecosystem of integrated solutions for ISO ClaimSearch which includes claim scoring, predictive analytics, third-party data, and visualization tools. Carlos brings to this role – and all ISO ClaimSearch participants – more than 30 years of experience in the property/casualty industry, where he has held a wide range of claims and technology roles. He is based in Jersey City, New Jersey and can be reached via email or 201-469-3103.