​By Marlon Fearon

The views expressed in this article are those of the author in his capacity as a member of the ICA Fraud Committee and do not necessarily reflect the views of Swiss Re or its affiliated entities.
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Life and health insurance exist to provide financial protection during some of the most vulnerable moments in a person’s life—illness, injury, disability, or death. Unfortunately, those same features that make these products essential also make them highly attractive targets for fraud. Across the insurance industry, life and health lines consistently experience significant fraud exposure due to a unique mix of emotional, financial, and structural factors.

​Case Managers need to be aware of the warning signs called “red flags” that indicate a claim may be fraudulent. Such signs may indicate the need for closer scrutiny and further investigation during the claims handling process. The existence of more than one fraud indicator does not necessarily mean that a claim is fraudulent. Indicators of fraud may exist purely through coincidence in legitimate claims. Claims that raise concerns need to be examined carefully before final conclusions are drawn.