"36% of the people surveyed say it is acceptable to pad insurance claims and 40% believe it is ok to overstate claims to avoid paying deductibles; Insurance Fraud costs firms $30 billion per year." Insurance Research Council, WSJ 2-12-98
Insurance companies have a unique set of problems when it comes to investigating fraud. First, they must assess all claims at face value rather then having incidents of fraud identified through other sources. Second, the claims that they must examine are submitted by their own clients. Third, as evidenced by the above statistics, clients often feel justified in submitting padded or overstated claims. This can make it much more difficult to assess a person’s credibility using conventional methods of interviewing. These facts demand that all aspects of the claim review are conducted with the utmost sensitivity. They require powerful, effective methods of investigation combined with demonstrated intent to support the client. The Tactical Interviewing Program explains the psychological issues confronting the client as well as the investigator. More importantly, it is the most efficient and non-intrusive method of determining whether information is accurate or misrepresented. In each case, evidence or facts pointing to fraud may be sorely lacking. But in every case, the client knows everything. The Tactical Interviewing Program teaches participants to assess the way in which the information is presented. Also, each word has the potential to reveal motivations and/or veracity. Even though some decisions must be made by Claims Representatives and Investigators without observing the client face to face, there is good news. Studies have shown that listening to a client’s report or simply reading it can be more accurate than observing a person as they are giving the information. The Tactical Interviewing Program’s method of Statement Analysis is perfectly suited for these types of situations: 1.) There is total belief in everything that the client reports during their initial interviews. Therefore, the client feels supported and receives the reassurance he/she deserves. 2.) Analyzing statements takes only a few minutes and is the most accurate means of verifying claims. (Note – Most interview techniques stress the search for signs of deception. If deception is what is looked for, possible deception is all that will be seen. The Tactical Interviewing Program is unique in that it teaches how to LOOK FOR TRUTHFULNESS, to support the client’s claim. This technique readily and easily identifies truthful claims. Investigators are reassured that they are not needlessly spending time and resources on cases that are not warranted. 3.) Claims Representatives and Investigators feel more confident in conducting their assessments. They quickly ascertain which areas of the claim need further investigation. Key factors contributing to the success of insurers in detecting fraud were identified by the Insurance Research Council as training, SIU investigations, centralized claims index databases, and the support of claims management – in that order of importance. The Tactical Interviewing Program has been utilized by law enforcement personnel and private companies alike to make sure that all victims receive the understanding, support, and guidance that they deserve. Victims will not feel that they are being re-traumatized while following the procedures that need to be taken to have their claims resolved. By utilizing the Tactical Interviewing method, your employees will be able to identify fraud while still offering the full measure of support that all clients deserve. In addition, the company will be able to make the best use of its resources to investigate fraud. The Tactical Interviewing Program insures no li(e)ability.