New Claims Reporting Format Increases Insurers' Ability to Detect Fraud

January 1, 2011 / 3 min read

NEW YORK, July 11, 2000 — Insurance companies' ability to detect fraudulent claims by cross-checking them in an "all-claims" database will become keener as insurers adopt new methods of reporting and coding claims beginning in July.

More than 4,000 insurers, self-insured entities, and third-party administrators now report claims to ISO ClaimSearchSM — the antifraud information system established by Insurance Services Office, Inc. (ISO) for auto, property, and liability claims. By cross-checking new claims against the 147 million records in the ISO ClaimSearch system, users can detect staged-accident rings, multiple claims for the same loss, and other types of fraud.

ISO developed the new Universal Format to standardize and enhance insurers' reporting of information to the ISO ClaimSearch system for all types of claims and to improve the utility of the system's information for handling claims and detecting fraud. For example, the system previously did not receive information on policy-inception dates for property claims. A loss date close to the inception date on a new policy may be an indicator of fraud.

This month, insurers began using the ISO ClaimSearch system's Universal Format to report policy-inception information and other data to the system that will significantly enhance fraud detection. The Universal Format also permits the ISO ClaimSearch system to issue reports to insurers in a single, easy-to-read format for all types of claims. Among the new data that the Universal Format provides are:

Policy-expiration dates and an indication of whether the policy is a renewal or a new one.
Catastrophe indicators to determine whether the claim was related to a catastrophe. Claim information also will include the catastrophe number from ISO's Property Claim Services unit.
Lawsuit indicators on whether or not the claimant has filed a lawsuit.
Fault indicators for the auto segment.
Antitheft device indicators of the type of antitheft device installed in an insured's vehicle.
Airbag status indicators on whether a vehicle's airbag was deployed, intact, or missing, which helps confirm the accuracy of a claim.

The Universal Format also makes it easy to update claim reports monthly, enabling claims professionals to determine the status of a claim — for example, whether it is open, closed or withdrawn.

Previously, companies reported to and received search results from the system's property, bodily injury, and auto segments in three separate formats.

"With the Universal Format, claims professionals will be able to spot potential fraud more easily and reliably because they'll receive consistent, integrated reports across insurance lines," said Richard P. Boehning, ISO's senior vice president.

To facilitate conversion to the Universal Format, ISO offers insurers three ways to obtain the new specifications: online from ISO's website at www.verisk.com; via e-mail from ISO ClaimSearch Customer Support at njsupport@iso.com; and in hard copy. For more information, call ISO ClaimSearch Support at 1-800-399-2585.

Insurers are waging a pitched battle against claims fraud — a $20 billion industry scourge that adds significantly to the cost of insurance.

ISO is the leading source of information about property and liability risk. ISO provides statistical, actuarial, underwriting, and claims information and analyses; consulting and technical services; policy language; and information about specific locations for a broad spectrum of commercial and personal lines of insurance. In the United States and around the world, ISO serves more than 2,900 insurers and reinsurers, as well as agents, brokers, self-insureds, risk managers, insurance regulators, and other government agencies.

Release: Immediate

Contacts:
Giuseppe Barone / Erica Helton
MWW Group (for ISO)
201-507-9500
gbarone@mww.com / ehelton@mww.com