Even though insurers have invested heavily in fraud-fighting technology, the percentage of referrals from automated systems accepted by special investigation units has declined to 15 percent from 22 percent in the past two years, the Coalition Against Insurance Fraud reported last week.
The Coalition’s biennial benchmarking report on insurer SIUs notes that investigators’ caseloads also declined in 2019 — to 10.7 per month from 12 for field investigators and from 24 to 17 for desk investigators. At the same time, insurers increased the number of desk investigators, who grew to 16 percent of SIU staff from 9 percent in 2017.
“One possible explanation is that with technology and training, desk and field investigators may be handling fewer but larger and more complex cases,” the report says. “Such cases require considerable time and resources. With the increase of insurer major-case units, the decline in caseload would be one result.”