Insurance fraud is an illegal act of exploiting an insurance contract. It’s generally an intentional deception perpetrated by (i.e., issuer fraud) or against (i.e., buyer fraud) an insurance agent or company for financial gain.
Worse yet, insurance fraudsters are constantly refining their schemes to determine new angles of attack. They are even now adapting to the digital world. The good thing is that social media investigations are increasingly turning the tables.
What Are Lines of Insurance Susceptible to Fraud?
The entire insurance market is prone to fraud, scams, and schemes. In particular, automobiles, health insurance in between jobs, and workers’ compensation are generally considered to be the most affected insurance lines.
Now, how does social media determine these fraudulent claims?
eDiscovery
The massive volume generated from social media offers almost endless court-admissible fraud evidence. Around one billion new posts are posted on any social media platform daily. Each of these posts can leave a trail that can potentially reveal deceitful insurance claims. This process of using social media as digital evidence is now referred to as eDiscovery.
Here are four things to keep in mind when doing an eDiscovery:
Look for Inconsistencies
Scouring inconsistencies in a claimant’s social media accounts are the sole purpose of eDiscovery in insurance fraud investigations. These inconsistencies could be present in one story on their claim yet could live out another.
Seek out Confessions
There are two kinds of fraudsters on social media. One who unintentionally reveals something on their private posts or messages, and another who shamelessly brags about their fraudulent behaviours in public.
Ask the Professionals
Smart fraudsters often create alternative social media accounts where they can freely post their schemes. It’s possible that claimants would unknowingly turn up themselves to their family or friends in these proxy profiles.
You don’t want to overlook any of these potential leads. This is when properly trained fraud investigative professionals can be of great help. These investigators can run a thorough investigation of the claimant’s proxy accounts, close contacts, tagged pictures, and even private messages, which may serve as valid evidentiary sources.
An ideal team of social media investigators should be composed of technical experts, experienced forensic professionals, certified private investigators, and licensed lawyers. In addition, each of them should be proficient in unearthing incontrovertible smoking guns.
Is It legal to use eDiscovery in insurance fraud investigations?
The data taken from social media platforms is called social data. Most social media platforms will hand over all social data of a user’s account so long as they receive an investigative subpoena for it. Moreover, while it’s possible to overcome privacy concerns, evidence should still be gathered legally to hold up in court.
Social Media Data Analytics Software and Tools
The plethora of information taken from social media clouds can be an issue. The data can be too much to rifle through at random and can’t be fully infiltrated by human eyes alone. That’s why insurance companies, consumers, and even investigators rely on leading-edge technology, primarily predictive analytics.
Here are among the cutting-edge data analytical tools that can link, parse, and analyze any social content and eventually determine frauds posted online:
- Predictive modelling can detect suspicious activities almost instantly. Its main goal is to prevent fraud from happening, rather than exerting more efforts on fraud recovery or spending money on fraudulent claims.
- Telemetry is one of the cross-leveraged data source technologies that can be used in the social media cloud. Telemetric data generally unmasks fraudsters. For example, installing telematics on any transportation, which is also known to promote safe driving behaviour, can reveal the truth behind accident claims.
- Text-mining software can parse and analyze unstructured text-based data. This tool aids investigators in examining emails, adjuster notes, interview records, service calls, and other internal claims information. CBSNews reported that this high-powered data mining software is now being used to examine LinkedIn, Facebook, Twitter, and Youtube.
- Social customer relationship management tools can sift through millions of social media posts on different platforms to identify past and recent fraud-related claims. Specifically, it searches for the specific relationships of people as viewed on various social networking sites. For example, one search can reveal that a car accident plaintiff is connected to the defendant on social networking.
- Social network analysis (SNA) functions almost the same as social customer relationship management tools. This tool can also take social media footprints. The only difference is the SNA doesn’t only uncover hidden relationships among people but also accounts, locations, and any other virtual entities.
Final Thoughts
With the aid of next-generation analytic technologies, insurance fraud investigators are detecting fraud more efficiently while ultimately keeping insurance costs down. Due to these improved applications, several courts are now permitting the discovery of social media content for insurance claim frauds.
