Oxxford Group, LLC

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Fraud Reporting

Recent legislation requires that insurance carriers adhere to certain criteria which address the problem of fraud.  Severe fines and/or penalties may be levied against companies that do not comply in the fight against fraud.  The majorities of states require that carriers file a fraud plan, establish and maintain a special investigation unit (SIU), and train their claims and underwriting personnel.

The SIU is responsible for conducting investigations of all claims referred to the unit that are deemed suspicious or believed to be fraudulent.  The referrals may be received from underwriters, claims processors, claims adjusters, other insurance company employees, law enforcement agencies and the general public.  The SIU is composed of employees who have knowledge and experience in claims practices and fraud investigations.  They have special training in the analysis of claims for patterns of fraud, specific red flags and other criteria indicating fraud.  The SIU staff has the ability to conduct effective investigations of suspected insurance fraud.

An investigation of suspected insurance fraud includes a thorough analysis of a claim file, application, or insurance transaction; identification and interviews of all witnesses who may possess information on the validity of the claim or application.  The SIU will also use all available industry recognized databases, gather and preserve evidence and upon completion of the investigation write a concise and complete report of all findings and a basis for the findings.  Upon finding of suspected fraud the SIU will refer the matter to the appropriate state Insurance Fraud Department with their report and findings.  Each state Insurance Department has different submission requirements.  For example in California the submission of suspected fraud must be referred within 30 days in Workers’ Compensation claims and within 60 days for all other claims.  This needs to be reported on a form prescribed by the Department.  The submission form must contain the fraud type, reporting party information, victim information, policy or claim information, other agency referral information, referral contact information, information for all parties associated with the suspected referral.

For AIG and its affiliates, report suspected fraud to AIGWIR by calling 1-866-CATCH-EM (1-866-228-2436) or sending an e-mail to aigfid@aig.com.

Fraud Training

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Oxxford Group, LLC

Insurance fraud is a serious problem that affects almost every aspect of our lives.  Insurance fraud raises the cost of coverage, forcing consumers to pay higher auto, health, home and life insurance premiums.  Ultimately, the cost of insurance fraud inflates the price of everything we buy.

To assist insurance and related industry constituents in claims cost control, Oxxford Group provides online/self-paced training on a wide range of insurance fraud subjects.

Trainees can earn continuing education/CE credits upon successful completion of a course.  Currently, CE credits are available in the state of Texas.  Other states will be added in the near future.

In order to qualify for CE credits, a trainee must:

Ø Spend the minimum required online study time (e.g., 50 minutes for a one hour course);

Ø Receive a passing grade by having a score of 70% or better on the course test; and

Ø Complete an evaluation questionnaire which will be emailed to you upon passing the test.

The CE certificate will be mailed to the address that you submit in the questionnaire.

All training courses are authored by subject matter experts who are senior investigators of AIG World Investigative Resources, Inc. (AIGWIR) with many years of law enforcement background and fraud investigation experience in the related lines of insurance business.

Email us with contact information if your company is interested in becoming a subscriber