EFI Global

Claims Staff Faster, Better At Fraud Detection Using Predictive Modeling

 Monday, January 4, 2016


A rather typical business story became a head-scratcher of a Workers’ Comp claim — and an illustration of the power of predictive modeling — when a seemingly “normal” claim was flagged for potential fraud. A person traveling for business stayed in a hotel, as many people do when they travel, but with a twist. He filed a Workers’ Compensation claim for supposedly suffering an injury after falling off a chair in his room. According to the claimant, he could no longer work, but he didn’t expect that a predictive modeling tool would flag his case based on his occupation and other factors, bringing it to the attention of the insurer’s Special Investigations Unit (SIU).
FraudRisk Management