Insurance Fraud Prevention Checklist
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Claim Submission Review
Verify completeness and accuracy of initial claim submissions.
Claim Submission Date
Claim Number
Claim Type
Narrative Description of Loss
Policyholder Verification Method
Supporting Documentation (Photos, Police Report)
Applicant/Insured Background Checks
Review criminal history, credit reports, and social media for red flags.
Credit Score
Criminal Record Check Status
Date of Background Check
Notes from Background Check Report
Prior Insurance Claims (select all that apply)
Copy of Criminal Record Check Report
Loss History Verification
Cross-reference reported loss history with MVRs, CLUE reports, and industry databases.
Number of Previous Claims
Date of Previous Claim (Most Recent)
CLUE Report Accessed?
Upload CLUE Report (if accessed)
MVR (Motor Vehicle Record) Checked?
Notes/Comments on Loss History Review
Witness Statement Analysis
Evaluate consistency and credibility of witness testimonies.
Witness Statement Content
Statement Consistency (with Police Report/Other Accounts)
Witness Demeanor (Observed)
Notes on Witness Behavior
Relationship to Insured/Claimant
Investigator Signature
Damage Assessment Verification
Confirm the reported damage aligns with the loss event and independent estimates.
Estimated Repair Cost (Initial)
Estimated Repair Cost (Independent Assessment)
Damage Severity
Photos of Damage (Before)
Detailed Description of Damage
Pre-existing Damage Indicated?
Date of Damage Assessment
Medical Records Scrutiny
Review medical records for inconsistencies, unusual treatment patterns, and duplicate billing.
Treatment Notes Review
Number of Visits
First Date of Treatment
Primary Diagnosis Consistency
Billing Code Discrepancies
Attached Scanned Records
Vehicle/Property Inspection
Document vehicle or property condition and any pre-existing damage.
Detailed Description of Vehicle/Property Condition
Pre-Existing Damage Count (e.g., Scratches, Dents)
Visible Signs of Tampering?
Photographs of Vehicle/Property (Front, Back, Sides, Damage)
GPS Coordinates of Inspection Location
Inspection Date
Inspector Signature
Policy Coverage Review
Confirm policy terms and conditions apply to the reported loss.
Policy Type
Coverage Amount (USD)
Policy Effective Date
Deductible Amount
Review Notes & Comments (e.g., specific endorsements, exclusions)
Business Interruption Coverage Included?
Flood Insurance Coverage?
Data Analytics Monitoring
Track claim patterns and identify potential fraud indicators using data analytics tools.
Average Claim Severity (USD)
Claim Frequency Rate (Claims/100 Policies)
Loss Ratio
Fraud Indicators Triggered (Select all that apply)
Date of Analytics Review
Summary of Analytics Findings
Reporting & Escalation
Document suspicious activities and escalate potentially fraudulent claims to the appropriate authorities.
Summary of Suspicious Activity
Estimated Fraudulent Value ($)
Severity Level (Low, Medium, High)
Date of Initial Suspicion
Assigned Investigator
Notes/Comments for Investigator
Supporting Documentation (optional)
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