Fraud measurement survey
In April 2004, 65 attendees of the Insurance Fraud Management conference in Phoenix participated in a conference session that asked them to complete a survey on their companies practices involving how they measure anti-fraud activities involving case referrals, fraud savings and performance evaluations of investigators. The conference session was led by Dennis Toomey of Liberty Mutual, Frank Sztuk of Allmerica Insurance and Dennis Jay of the Coalition Against Insurance Fraud. Below are the results of the survey. Additional analysis of the survey will be available at a later date.
Referrals
1. Do you track the percentage of claims that are referred to SIU?
Yes |
86% | |
No |
14% |
If yes, what was your referral rate for 2003?
Less than 1% |
25% | |
1% to 3% |
39% | |
More than 3%, less than 5% |
23% | |
Greater than 5% |
13% |
2. How useful would it be to you to compare your referral rate to an industry average?
Very useful |
57% | |
Somewhat useful |
40% | |
Not useful at all |
3% |
3. Would you and your company be willing to share your rates of referral by line of business with the Coalition Against Insurance Fraud on a confidential basis to help develop industry averages?
Yes |
69% | |
No |
2% | |
Maybe |
28% |
Savings
4. Does your company track the amount of savings incurred as a result of anti-fraud activities?
Yes |
80% | |
No |
20% |
If so . . .
5. What factors are used to calculate savings?
Total claims payout |
25 (number of responses) | |
Reserves |
36 | |
Actual potential payout |
33 | |
Compromises |
30 | |
Other |
12 |
6. Does any non-SIU department within your company audit or assist in determining the savings amount?
Yes |
48% | |
No |
52% |
7. Do you believe that the calculated total is an accurate reflection of real savings your SIU brings to your company?
Yes |
10% | |
No |
90% |
8. Do you feel that the aggregate total of savings your company reports to state insurance departments accurately reflects your total anti-fraud efforts?
Yes |
3% | |
No |
97% |
Performance evaluation
9. What are the top three factors that your company uses
to measure the performance of individual investigators?
Quality & accuracy of investigations |
59 (number of responses) | |
Number of investigations |
38 | |
Closing ratio |
24 | |
Average days open |
18 | |
Recovered premium |
1 | |
Averaged paid |
4 | |
Assists |
7 | |
Training |
16 | |
Savings |
11 | |
Other |
9 |
10. Does your performance system take
into consideration complex cases vs. simple ones?
Yes |
56% | |
No |
44% |
11. In a case where an urban medical provider submits 100 questionable claims, does your performance system count this as:
One case |
29% | |
100 cases |
47% | |
Other |
24% |
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