Course Outline

Module 1: Introduction to Insurance Investigations

• Role and importance of investigations in insurance

• Common types of fraud in insurance claims

• Legal and regulatory framework for insurance investigations

• Case study: High-profile insurance fraud cases

Module 2: Investigative Techniques and Evidence Gathering

• Methods of collecting and verifying claim information

• Conducting interviews and statement analysis

• Surveillance techniques and ethical considerations

• Case study: Investigating a staged accident claim

Module 3: Fraud Detection and Risk Indicators

• Red flags in various types of insurance claims (health, motor, property, life)

• Utilizing data analytics and AI in fraud detection

• Working with forensic experts and fraud analysts

• Case study: Detecting fraud in disability and workers’ compensation claims

Module 4: Legal and Ethical Considerations in Investigations

• Admissibility of evidence in insurance investigations

• Privacy laws and confidentiality in investigative processes

• Ethical decision-making in insurance fraud cases

• Case study: Legal challenges in insurance fraud prosecution

Module 5: Reporting, Documentation, and Case Resolution

• Preparing investigation reports and presenting findings

• Working with law enforcement and legal teams

• Negotiating settlements and claim resolutions

• Case study: Successfully resolving a disputed claim through investigation