Special investigation units and auditing departments of insurance companies will benefit from WizSoft data mining and text mining software tools – WizRule, WizWhy, WizSameWizDoc, in investigations involving the following applications:

Worker Compensation Fraud – Some businesses illegally try to avoid paying full state-required workers compensation premiums.

  • One scheme involves paying workers off the books because the number of employees is a factor in determining a business’s premiums.
  • Another scheme involves misclassifying employees in high-risk jobs as holding lower-risk jobs.

Auto Insurance – Underwriting Fraud: Dishonest drivers try to lower auto premiums by lying on their insurance application or renewal. For example:

  • Registering their vehicles in localities where premiums are lower, even if they don’t live there.
  • Low-bawling their stated mileage.
  • Declaring a commercial vehicle is used for personal use.

Money Laundering and Suspicious Transactions Involving Insurance – the following examples may be indicators of suspicious transactions to be investigated:

  • Application for business outside the policyholder’s normal pattern of business
  • An atypical incident of pre-payment of insurance premiums
  • Insurance policies with premiums that exceed the client’s apparent means
  • Insurance policies with values that appear to be inconsistent with client’s insurance needs
  • Any transaction involving an undisclosed party
  • A transfer of the benefit of a product to an apparently unrelated third party
  • Using a third party’s checks to pay a proposed purchase of a policy

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