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Special Investigations Unit (SIU)

Fraud costs an estimated $34 billion a year across the property and casualty insurance industry, according to the Insurance Information Institute, and comprises an estimated 10 percent of industry losses.* At CNA, we take fraud seriously. Our global Special Investigations Unit (SIU) works diligently to protect our policyholders by uncovering and investigating suspect claims, and collaborates with law enforcement agencies to assist with investigations leading to arrests and convictions of guilty parties.

Our best asset is our experience
Combating insurance fraud requires a deep and experienced team. Our SIU professionals have backgrounds in criminal and civil investigations, law enforcement, medical, business intelligence, analytics and claims handling.  CNA’s Special Investigation professionals identify, investigate and deter insurance fraud while mitigating the risk of fraud losses to our policyholders.
Our SIU team has strategic partnerships with a global network of private investigators, antifraud legal counsel and some of the top Insurtech firms specializing in advanced predictive analytics and technology tools; who are able to assist with our investigative strategy in a timely and efficient manner.

A trusted partner, nearby
CNA has regional offices throughout the U.S., Canada, Europe and Asia. We have Underwriting, Risk Control and Claim professionals who understand the unique needs of your business environment and who can deliver the right solutions for your business.

Outstanding services and tools that identify fraud:
  

  • Scene inspection: Thoroughly investigates loss locations to validate the reported circumstances, obtain necessary photographs or source other pertinent information.
      
  • Evidence gathering: Collectively compiles information from multiple sources to affect the correct claim decisions, accomplished through interviews with involved parties and witnesses, and by obtaining court records and documentation that’s relative to the reported loss.
      
  • Surveillance: Accurately determines an injured worker’s level of activity to identify concurrent employment, which could render the claimant’s medical restrictions out of scope.
      
  • Background and medical records research: Comprehensively utilizes social network data mining and intelligent medical information tools to determine if an individual’s behavior coincides with a reported loss.
      

SIU tools and business partners include: 
  

  • Data analytics: Systematically sources medical provider treatment and billing records to identify patterns of abnormal behavior, in both individual claims as well as those spanning multiple claims and lines of business.
      
  • Social network data mining: Comprehensively pulls data from social networking sites to aid our SIU analysts as they gather information that may corroborate suspected fraud. Data mining assists with identifying possible associations between various parties to a claim, including claimants, medical providers, attorneys and witnesses. By using these tools, the SIU team can identify patterns of questionable behavior and activity that may otherwise remain undetected.
      
  • Link analysis: Visually connects networks and relationships, which aids our investigators when uncovering possible associations between involved parties to a claim.
      
  • National Insurance Crime Bureau (NICB): Enables us to quickly and efficiently identify high-risk claims, by researching specific data within CNA’s claim volume. In addition, the NICB provides jurisdictional expertise for each of our lines of business and acts as a resource for external fraud training. We also turn to the NICB’s Major Medical Fraud Task Forces for investigative support and to assist with large scale medical provider/organized fraud investigations.
      
  • Coalition Against Insurance Fraud (CAIF): Provides outreach, education and information on combatting insurance fraud. As a member company, CNA receives practical tools, including the latest trend reports on fraud, legislative updates and other research that supports our anti-fraud efforts.
      
  • Federal/state/local enforcement agencies: Acts as an additional venue to refer suspect claims that have the potential for criminal investigation and prosecution.
      

Superior in-house resources you need
Our SIU team works to stay one step ahead of the criminals and uses specialized services to identify new and emerging fraud trends.
 

Case management: Oversees day-to-day claim investigation operations and delivers subject-matter expertise to assist in the identification of suspect claim activities and the development of investigations.

Major case investigations: Provides an enhanced focus on complex, high-risk claim exposures, such as organized crime-rings, medical provider treatment fraud and medical provider billing fraud.

Intelligence analysts: Investigates internal and external sources of information to assess suspected fraudulent claims or provider activity, and creates business intelligence reports that advance fraud identification and prevention efforts.

Clinical investigator: Provides knowledge and expertise of medical practices and standards, and also identifies and prevents medical provider fraud, waste and abuse by interpreting medical practice guides and other standards of practice.
 

CNA customers may contact SIU directly by emailing fraud@cna.com or calling 866-262-3116.

*Source: https://www.iii.org/article/background-on-insurance-fraud

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