The Company will work to foster open communication and support for other fraud control entities such as federal, state, and local law enforcement, state fraud bureaus and the National Insurance Crime Bureau.
The purpose and goal of our Anti-Fraud Plan is to educate, detect, investigate and deter insurance fraud thereby reducing insurance costs.
As part of the Company's management process, the InsureMax Insurance Company's claim staff will endeavor to thoroughly review each claim and identify those claims exhibiting fraud related indications, red flag events and situations or behavior indicative of fraud schemes. As such, the Company's claim staff will act as the first phase in detecting questionable claims and will refer them to the appropriate investigative unit for further analysis. The investigative unit will also act in an advisory capacity to the underwriting department.
Special investigations will include the application of techniques and resources to resolve fraud issues. Investigative results are used to decide which course of action is warranted. Recommendations may include claim payment, claim reduction, claim denial or opportunity to withdraw claim, or the pursuit of restitution if the claim was paid, and possible law enforcement referral.
Special Investigation Unit (S.I.U.)
The Company has an S.I.U. composed of a four person anti-fraud review committee responsible for review, reporting, and the appropriate resolution of all suspected fraudulent insurance acts.
Insurance Fraud will not be condoned by InsureMax Insurance Company. Our personnel are dedicated to the prevention of insurance fraud and will aggressively review, analyze, monitor, investigate and prosecute to the fullest extent of the law fraudulent insurance acts. It is our position that the validity of such acts will receive the benefit of the doubt unless proven otherwise through complete investigation and evaluation toward their appropriate disposition. These acts in general are, but not limited to:
- Application Fraud
- Certificate of Insurance Fraud
- Fraudulent Insurance Claims
- Understating Rating Exposures such as Sales, Payroll, etc.
Further, we will comply with state statutes with respect to the reporting, investigation and preparation of Anti-Fraud Plans.
Suspected fraudulent insurance acts must be reported to the respective State Fraud Bureau where applicable. Those acts involving InsureMax Insurance Company should be referred to the company using the sample referral form.
All suspected fraudulent insurance act referrals including supporting documentation should be forwarded to "Compliance Officer", InsureMax Insurance Company, 4976 State Route 261, Newburgh, IN 47630.