TIA2023 Task Solutions... maybe it was not that obvious? - Episode 4 - Insurance Crime Bureau (ICB)
We asked the TIA2023 task sponsors to guide us, as to what they were looking for in their tasks. Below is a for Episode 4 from Insurance Crime Bureau (ICB).
South Africa continues to move through increased economic hardship and infrastructure instability, in turn, the levels of poverty likewise are increasing. This challenge is now particularly prevalent, with the flat economy creating high levels of unemployment and creating economic desperation.
The Insurance Apprentice 2023 contestants were tasked with establishing an effective solution to address the threat of organised cross-carrier insurance fraud as detailed below.
Detailing the task
They were told that they were all executives within different insurers in South Africa. Their challenge was that their companies were all starting to experience a significant uptick in fraudulent claims attributed to the use of identity theft and money mules.
They were tasked with the responsibility of establishing an effective solution to address the threat of organised cross-carrier fraud.
In detailing the task, we explained the difference between opportunism versus criminal enterprise.
Insurance is a competitive business where clients come first, and the best turnaround times are part of the industry initiative to retain and gain clients. As such, it is common practice to fast-track the validation and settlement of certain claims. Although this is a client-orientated initiative, it creates an environment where fraud is most likely to be encountered.
Misrepresentation to insurers about insurable incidents has been a common phenomenon.
Criminal enterprises study the insurance industry and are familiar with all the red flags used in validating claims. These criminal enterprises seek to gain maximum financial profit through fraudulent misrepresentation from underwriting to claims. To avoid detection, the criminals need to remain undetected and, therefore, make use of identity theft, money mules, fake companies, service providers, and even staff within companies to succeed in remaining anonymous. Criminal enterprises will not only target one insurer but will do so with all insurers on a cross-carrier basis, avoiding compromising a profile.
The desired solution
The desired solution was to use a community-based solution such as the Insurance Crime Bureau, which was originally formed to facilitate common-cause crime-fighting activities. The Latin word “Communitas” refers to large group affiliations at either National or International level, which may also include virtual communities.
The Insurance Crime Bureau is a non-profit company dedicated to fighting organised insurance fraud and related crimes. The organisation has had a significant impact on both the non-life (short-term) and life (long-term) insurance industries and on broader society.
The information below was provided to the contestants, to use in their deliberations.
THE ICB VISION
The Insurance Crime Bureau was established in 2008, to be the intelligence hub, and leading authority on organised crime, operating within the insurance industry.
THE ICB MISSION
The Insurance Crime Bureau aims to achieve its vision through the consolidation of multiple data sources, and the deployment of relevant and specialised skills along with unique technology, all to promote collaboration and provide intelligence to detect and prevent insurance-related fraud and crime… with the end goal of obtaining convictions and recoveries.
Links to the Annual Reports were also provided:
https://www.saicb.co.za/news/2021/insurance-crime-bureau-2021-annual-report
https://www.saicb.co.za/news/2022/insurance-crime-bureau-2022-annual-report
This was a difficult task that took the contestants out of their comfort zone and the resultant presentations, which you can watch in the Insurance Crime Bureau episode, were interesting.
Garth de Klerk
CEO
Insurance Crime Bureau
