Special investigation units and auditing departments of insurance companies will benefit from WizSoft data mining and text mining software tools – WizRule, WizWhy, WizSame, WizDoc, 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
