Can You Spot the Red Flags
in These Claim Scenarios?

Most claims are legitimate, but some are fraudulent. Therefore, it is appropriate for the adjuster to review all claims for possible fraud. An adjuster can more easily determine the "fraud probability" of a claim by recognizing various fraud indicators.

These indicators should help isolate those claims which merit closer scrutiny. No one indicator by itself is necessarily suspicious. Even the presence of several indicators, while suggestive of possible fraud, does not mean that fraud has been committed. Indicators of possible fraud are “red flags” only, not actual evidence.

Some claims, although suspicious, may have to be paid for lack of conclusive evidence of fraud. However, they should be referred to your SIU for further review.