In relation to the letter by James Pinder (Insurance Times, May 17) regarding Bill Jackson's Core fraud screening system, I could not agree more as to the absolute need for evidence when making a decision about a claim.
This issue is regularly commented on by the Ombudsman's office to insurers and their agents, but it goes further by advising the evidence be collected as early as possible, as opposed to leaving this vital task until a challenge to a decision is made.
I am not sure Mr Pinder fully understands the sophistication of the screening technique (that fully supports evidence gathering) advocated by Mr Jackson. The big difference with this technique is the number of disciplines it brings together in order to accurately assess the risk in a claim. In fairness to Mr Pinder, it is its uniqueness and the break with traditional thought that, until more fully explained, is often the barrier to its appreciation.
Here are some of its key features. It conducts the screening solely over the telephone and delivers the highest standards of customer care in a structured way, even to the blatant fraudster. It systematically obtains the story behind the claim – it tests claimants' working memory and requests an explanation for any lapses and evaluates those explanations. It begins the evidence trail from the first utterance by the claimant – it captures the material facts within the claim and looks for corroboration to confirm or rebut those facts.
Finally, if a personal visit is required, the field investigator will be better informed as to all the anomalies in the claim.
As a consequence, I would be surprised that, if the claim had been handled in this way, a genuine claimant would be “put off”, as Mr Pinder puts it. Although difficult to measure such disaffection, one indication would be if claimants obtaining a settlement did not renew their insurance when it was due, or by measuring customer complaints.
I'm pleased to say there is no evidence to suggest customers are being put off and the number of complimentary letters has increased eightfold, which speaks for itself.
While no one has invented a process that combats 100% of fraud, and never will, the need to continue looking for and trying new methodologies is now a commercial imperative. Already the enlightened insurers are reaping considerable financial and customer service benefits from the use of such screening techniques, thus encouraging the fraud-minded to move to easier targets within the same industry. It is my view there is considerable displacement of the problem to those using the more traditionalist approach to handling claims, where the evidence is gathered late, unsystematically or not at all.
Fraud solutions manager (UK)
Crawford and Company
Simple, yet effective
I welcomed James Pinder's supportive comments in his letter (Insurance Times, May 17) regarding Empathic Risk Assessment (New Era) screening and its application to fraud in insurance claims management. However, it is a relatively new concept, which can be difficult to immediately come to terms with.
What New Era screening is not is psychological profiling. Not that there is anything wrong with profiling, or the use of technology, reference to database systems, responding to “gut” feeling or score cards – all can, and often do, play an important role as filtering devices within a comprehensive fraud management system. Their purpose, however, is purely to identify risk. What they cannot do is produce real, usable evidence on which to justify or, if necessary, defend a decision. And that, contrary to what Mr Pinder believes, is what New Era is designed to do, in a customer-focused way.
Regarding Mr Pinder's point as to disadvantaging the genuine customer, New Era operatives are trained to give due recognition to the “genuine” reasons why some customers may not be able to recall all the facts. The process focuses on screening the genuine customer. There is statistical data to support this contention, with the latest figures from Thomas Cook showing that the number of customer complaints has dropped by more than two-thirds since implementing this process.
New Era is designed to focus on fraud in volume. In this context, we have to remember that the level of prosecution against insurance fraudsters is miniscule compared to the level of fraud. While prosecutions undoubtedly play a part in discouraging fraud, the studies suggest that the majority of claimant fraud is being committed by opportunists – ordinary people who do not necessarily see themselves as criminals, people who can be discouraged relatively easily .
At the same time, none of the elements that are brought together within the New Era process are totally revolutionary. What is radical about our process is that it is designed specifically for use over the telephone. Nevertheless, Mr Pinder may be pleased to learn that the techniques also have utility in a field environment, a fact that is being used to real advantage by McLarens Toplis's team of special investigators.
It may not be easy to accept that something based on such simple ideas can be so comprehensively effective. So, Mr Pinder, you are welcome to come and take a closer look at New Era, as indeed is anyone else who wants to take 10% off their claims bill.
Now that insurance companies are saying they will only deal with General Insurance Standards Council (GISC) registered intermediaries, it can only be a matter of time before intermediaries are forced to join this new organisation or lose their livelihoods.
Having looked at the GISC rules, it is clear that these are for the protection of the policy-buying public and do nothing for the intermediary.
It may be my cynical view but it seems to me that the first step is to identify who you are dealing with (registration with GISC) and, once this has been done, rules and regulations can be imposed with little or no consultation.
We already have an organisation in place to promote professionalism and qualifications within the insurance industry, the Chartered Insurance Institute (CII). But there is little or no compulsion to obtain any qualifications to practice insurance.
Let us hope that in the future the GISC and CII will talk together as a common voice to promote the services of GISC-registered intermediaries to the insurance-buying public.
At a loss
Regarding your profile article on Malcolm Harvey (Insurance Times, May 17) and his comments on loss adjusters. I own a private design and surveying practice and have been an active loss assessor over a period exceeding 20 years.
I am an acknowledged expert in subsidence claims and give lectures and write technical papers on the subject.
My experience with loss assessors through my institute has given me a deep respect for the dedication, knowledge and experience of its membership. As such, I find Mr Harvey's comments most objectionable.