Unmasking the Shadows: The Haunting Tale of Insurance Fraud

How to detect fraud in insurance companies

At this moment, an insurance company is being defrauded without their knowledge.
Mauro Nadav – Fraud Solutions Expert

There are many ways to defraud an insurance company. Fraud can come from outside the company through customers, service providers, etc., and from within through employees and subcontractors such as investigators and brokers.

Frauds can be simple or complex. Some of these frauds are subtle and often undetectable by traditional means. Most fraud cases are carried out by ordinary people, but there are also professional criminals that act methodically and can bypass all of a company’s defences.

Unveiling the Tip of the Iceberg

Once, while working at a large insurance company, I made a data inquiry regarding automobile claims. The data provided me with percentages of different claim types, including accidents, thefts, fires, and more.

Curious to delve deeper, I also asked for the number of cases handled by each company. To ensure accuracy and avoid potential data coincidences, I decided to increase and decrease the claim percentages by 20%. After comparing the adjusted figures with the data from the brokers, one particular case caught my attention the most.

The data for car theft indicated a staggering 50% increase compared to the insurance company’s average when I factored in my 20% adjusted increase. This particular company presented a number that was significantly beyond the usual range.

When I presented my study to the responsible parties in the claims department, they were all speechless. They had never considered looking for fraud in the way I did it. Their concern had always been to prevent fraud committed by customers, and occasionally by providers, but they had never imagined that “partner” companies could be defrauding the company.

I explained that this particular company was just the tip of the iceberg, and if they looked deeper, they would find more cases lurking beneath the surface, waiting to be discovered.

The Role of Emotion Logic in Fraud Detection

The scoring software utilized by the majority of insurance companies requires constant updates to combat emerging forms of fraud that arise daily. There is a need for vigilant monitoring of insurance claims to detect fraudulent activities, and this information is then used to establish correlations with vehicle types, customers, and other relevant factors. These correlations can lead to the creation of new rules within the scoring program to enhance fraud prevention.

However, it’s essential to note that such scoring programs are not equipped to evaluate agents or other entities involved in fraud prevention. Their focus is primarily on assessing individual claims and identifying patterns of fraudulent behavior in the data. Evaluating the role of agents and other actors requires a different approach and system that can comprehensively analyze their involvement in the prevention of fraud.

How Layered Voice Analysis (LVA) Technology Works

The Layered Voice Analysis (LVA) technology offered by Emotion Logic addresses these challenges effectively. It provides a comprehensive solution for handling insurance claims, from initial receipt to assessment by decision-makers for payment or investigation, and finally, scrutiny by investigators. The LVA technology can also be utilized with service providers and partners involved in the claims process.

By employing specially designed scripts to extract essential information and clarify facts, the LVA technology helps detect previously unknown instances of fraud. This prevention of fraudulent claims allows insurance companies to gain accurate insights into each claim and make informed decisions. Additionally, when necessary, new rules can be formulated for the scoring software based on the information gathered through LVA analysis. LVA technology empowers insurance companies to ascertain the truth behind every claim, enhance fraud prevention, and improve the overall efficiency and accuracy of the claim’s evaluation process.

Language-Independent and Unbiased

Emotion Logic is entirely language-independent and free from any biases related to age, race, religion, or gender. It can objectively identify any discrepancies or issues within the information provided, regardless of the speaker’s characteristics. By carefully analyzing the content of what was said, Emotion Logic enables quicker identification of problem areas and facilitates expedited decision-making processes.

With this capability, Emotion Logic streamlines the next steps in various processes, saving valuable time and accelerating the actions taken in response to the information received. Its unbiased and efficient analysis contributes to improved decision-making and enhanced overall efficiency in a wide range of applications and industries.


Through the utilization of this formidable technology insurance companies can prevent losses arising from internal or external processes. By gaining better insights into their stakeholders, relationships and procedures are significantly enhanced, fostering increased confidence and productivity. Embrace this technology to improve interactions with all parties involved in the claims receiving and settlement process.

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