in this business, we are intimately familiar with liars and their fibs and foibles, which are anything but pretty. Presumably registering high on narcissistic personality traits, some of them find a comfortable place in
today’s culture of oversharing. Moreover, inadequate
prosecutorial resources seem to embolden these liars,
who, under the perceived impunity of social media,
tout exploits as if to taunt insurance carriers and law
enforcement agencies alike.
ture sports while collecting workers’
The Coalition’s yearly roundup is a
testament to scammers’ brazen cunning,
with their naiveté and recklessness often portrayed in nearly equal measure
on Facebook, Twitter, and other social
networking sites. To thwart opportunistic fraud and address the proliferation
of organized crime rings, P&C insurers
must employ an arsenal of investigative
techniques. As a growing number of
claims managers and SIU directors can
attest, multi-layered approaches to fraud
tend to produce the most encouraging
results, with social media as a key ingredient in investigative success.
of claims investigation, as James Ruoto-
lo, principal for insurance fraud solu-
tions at SAS, points out:
“Technologies like text mining, sen-
timent analysis, content categorization
and social network analysis can auto-
mate social media research and be inte-
grated into the fraud identification and
predictive modeling process,” he says.
Such tools are useful in uncovering
complex operations, such as those abusing the Florida and New York personal
injury protection (PIP) systems, along
with more blatant cases of fraud—as in
scammers incriminating themselves by
posting pictures of engaging in adven-
It’s important to keep that a claims investigation is rarely as simple as a Facebook
user with lax privacy settings and a penchant for recklessness. In another sense,
social media serves as a useful, open-source
intelligence research tool to identify leads
and corroborate information.
Beyond injury claims, such as slip and
falls and workers’ compensation disputes, technology enabled social media
intelligence is enhancing fraud detection
across auto, property, liability and other
lines of business. Take, for example, the
white paper titled, “Combating Insurance Claims Fraud” in which SAS details how its social-network analysis has
proven effective in identifying organized
fraud activities by modeling relationships between entities in claims.
“Entities may be defined as locations,
service providers, telephone numbers,
and VINs,” according to the SAS report.
“Tools can be tuned to display link frequencies that exceed a programmed
Sleuthing Or Snooping?
Social media in claims investigations
is certainly not a novel idea, though its
application is continually being refined.
However, this veritable investigative
goldmine—which can provide clues as
to a claimant’s connections, background,
education, and whereabouts—is not
without its caveats, including privacy
concerns for which there is a growing
body of case law.
This is to say nothing of the legions of
“John Smiths” (trying Googling him) who
cry foul. Again, public relations challenges are anything but foreign to insurers.
Even though insurance fraud has become
a $30 billion-per-year racket according
to the Insurance Information Institute
(I.I.I.), the public remains somewhat apathetic, seemingly more concerned with
the possible encroachment of personal
liberty than fraud’s massive drain on the
economy, as well as the proverbial pocketbook in the form of higher premiums.
Nevertheless, there is a startling
amount of potentially useful information in social media sites, with advanced
analytics continually changing the face
fraud, lies and surveillanCe
Social media has irrevocably changed the nature of insurance claims
investigations. Mining data from popular websites has become an
essential part of the insurer’s multi-layered integrated anti-fraud
approach, which leverages both soft and technical capabilities.
Claims adjusters and SIU professionals must sift through a dizzying
array of data, all the while relaying on a combination of razor-sharp
methodologies, wit, and intuition to ensure that countless hours aren’t
spent pursuing virtual dead ends. Savvy sleuths are finding social
media to be increasingly effective in identifying criminal connections,
including potential associates, co-conspirators, as well as locate
witnesses, employment information, past education, date of birth,
medical providers, affiliations to local clubs and organizations, and
even the loss events themselves.
For example, Facebook’s location services allows users to share their
whereabouts with “friends” by checking in at a bar, eatery, park or
city. As evident in the anecdote below, this is not always to the user’s
advantage, at least if he is committing fraud:
A man’s Facebook page indicates that he “checked in” at a
local indoor rock-climbing facility via his iPhone on a Saturday
afternoon. It seems probable that he was participating and not
merely acting as a spectator, prompting investigators to question
an injury claim for which he has been collecting benefits.