Exero Group | Insurance Fraud Investigations

Comprehensive Solutions to Protect Against Fraud

Underwriting Due Diligence

Establishing Accuracy Before the Risk Begins

Proper underwriting is the cornerstone of effective insurance practices. Exero Group’s underwriting due diligence ensures that policies are based on accurate, reliable information, reducing risk and preventing fraud at the outset.
Policyholder Background Checks: Validate personal, business, and financial disclosures to confirm the accuracy of applications.
Asset Verification: Verify declared properties, vehicles, or other assets to ensure alignment with policy terms.
Risk Assessment with OSINT: Use open-source intelligence to identify high-risk behaviors, undisclosed business ventures, or inconsistencies in lifestyle or declarations.
Financial Integrity Reviews: Detect misrepresented income, overvalued assets, or hidden financial liabilities.
Commercial Underwriting Reviews: Assess businesses for legitimacy, operational risks, and compliance to ensure appropriate coverage limits and identify potential red flags.

Workers’ Compensation Claims Investigations

Ensuring the Validity of Workplace Injury Claims

Workers’ compensation claims can be costly, particularly when fraud is involved. Exero Group provides targeted investigations to confirm the legitimacy of claims and identify discrepancies.
Surveillance: Monitor claimants to identify physical activities inconsistent with reported injuries.
SOCMINT Investigations: Analyze social media posts, photos, or videos that conflict with the claimant's alleged condition.
Witness Interviews: Gather firsthand accounts to verify claims and clarify incident details.
Other Employment Verification: Identify undeclared employment that contradicts a claimant’s inability to work.
Medical Records Analysis: Review medical documentation for inconsistencies, fabricated injuries, or exaggerated claims.

Automobile Liability Claims Investigations

Providing Clarity in Auto-Related Disputes

Exero Group investigates automobile liability claims, ensuring accurate resolution of disputes and identification of potential fraud.
Accident Scene Analysis: Reconstruct accidents using evidence, diagrams, and eyewitness reports.
Damage Verification: Evaluate vehicle damage to ensure consistency with reported events.
Involved Parties and Witness Interviews: Interview all involved parties and known witnesses to get their statement on what happened.
Fraud Detection via OSINT: Analyze digital activity for evidence of staged accidents, such as coordinated social media interactions or undeclared modifications to vehicles.
Vehicle Maintenance and History Reviews: Examine maintenance records and vehicle history for evidence of pre-existing damage, improper repairs, or inconsistencies in the claim.

Property and Casualty Claims Investigations

Comprehensive Investigations to Protect Against Exaggerated Claims

Property and casualty claims often involve complex factors requiring meticulous review.
Damage Assessments: Confirm whether damages match the cause and event reported in the claim.
Cause Investigations: Determine whether damages resulted from covered perils or excluded factors.
OSINT for Verification: Leverage open-source intelligence to uncover undisclosed activities or circumstances surrounding the property in question.
Fraudulent Documentation Detection: Examine supporting documents, such as repair estimates or receipts, for signs of forgery or manipulation.
Pre-Loss Condition Analysis: Verify the condition of the property before the reported incident to ensure claims reflect accurate damages.

Homeowner Fraud Claims Investigations

Protecting Against Fraudulent Homeowner Claims

Exero Group investigates homeowner claims for signs of exaggeration or deceit.
Property Damage Verification: Examine claims related to fires, floods, theft, or vandalism to confirm validity.
Undeclared Renovations or Risks: Use OSINT to detect undisclosed property modifications or risky activities affecting coverage.
Activity Monitoring: Verify claimant behavior to rule out attempts to profit from pre-existing damages.
Disaster Fraud Investigations: Identify exaggerated or false claims filed in connection with natural disasters or other catastrophic events.
Policy Coverage Compliance: Confirm that claimed damages align with the terms and limits of the homeowner’s insurance policy.

Healthcare Fraud Investigations

Uncovering Misuse in Healthcare Claims

Healthcare claims can be exploited by both claimants and providers. Exero Group investigates irregularities with precision.
Provider Fraud: Detect patterns of unnecessary or duplicate billing.
Claimant Surveillance: Monitor claimants for activities inconsistent with their reported medical conditions.
Network Analysis with OSINT: Identify relationships between providers and claimants that suggest collusion.
Medical Document Verification: Review medical records and certifications to confirm authenticity and accuracy.
Fraudulent Billing Investigations: Identify fraudulent claims for services, treatments, or equipment that were never rendered or provided.

Sick Leave Fraud Investigations

Preventing Abuse of Sick Pay Benefits

Fraudulent sick pay claims cost employers time and money.
Activity Verification: Discreetly observe claimants to confirm their reported health condition.
Digital Data Analysis: Use OSINT to uncover activities such as secondary employment or travel.
Medical Documentation Reviews: Verify the authenticity of medical certifications supporting the claim.
Employment Verification Checks: Investigate potential undisclosed employment that contradicts claimed illness or injury.
Social Media Monitoring: Identify online posts or photos that reveal activities inconsistent with reported conditions.

Life and Disability Fraud Investigations

Safeguarding Against False Disability and Life Claims

Life and disability fraud can take many forms, from staged deaths to fabricated injuries.
Disability Verifications: Confirm the claimant’s inability to work through surveillance and investigations.
Life Insurance Fraud Detection: Investigate suspicious deaths or disappearances, including verifying documentation and circumstances.
Financial Background Reviews: Identify undisclosed financial motives or irregularities tied to claims.
Medical Record Analysis: Scrutinize medical records for inconsistencies or fabricated injuries.
Beneficiary and Policy History Checks: Validate the legitimacy of beneficiaries and analyze policy changes that may indicate fraudulent intentions.

Premium Fraud Investigations

Ensuring Honest Reporting in Policy Premiums

Misrepresentation of payroll, employee classifications, or business risk exposure can result in significant premium losses.
Audit Reviews: Verify payroll, risk classifications, and other policy-related information.
Surveillance of Business Practices: Confirm whether actual operations align with declared activities.
OSINT Analysis: Identify inconsistencies through public data, such as job postings or reviews.
Undeclared Workforce Investigations: Detect unreported employees or contractors that impact premium calculations.
Policy History Analysis: Examine previous claims and policy changes for patterns indicative of fraudulent behavior.

Agent and Industry Fraud Investigations

Preventing Fraud from Within

Fraud isn’t always external. Exero Group investigates fraud within the insurance industry itself, protecting your organization’s reputation and bottom line.
Agent Misrepresentation: Investigate agents for false policies, inflated premiums, or pocketing premiums without issuing coverage.
Insider Fraud Detection: Detect embezzlement or unauthorized activities within insurance organizations.
Compliance Audits: Ensure adherence to industry standards and legal requirements.
Policy Forgery Investigations: Uncover falsified documents or altered claims submitted by internal personnel.
Conflict of Interest Analysis: Identify relationships or transactions that could compromise ethical decision-making or operational integrity.

Insurance Fraud Investigations