1. Hypothetical Example of a Social Network Containing Fraud – Individual Insurance*
$1.26 million value of claims
14 claims
8 accidents
5 new policies
* For a detailed insight, read the Notes below the slides.
Fraud Management, Confidential 1

2. 2009 – Five new policies
5 new policies are obtained from 4 different insurers.
At this point, there are some cell phone links between the policies
Fraud Management, Confidential 2

3. 2009 October – Accident 1 Accident 1 4 subjective injuries reported
Claims made against 2 insurers
Total value $395,000
Fraud Management, Confidential 3

4. 2009 October – Accident 2 Accident 2 Occurs 3 days after accident 1
3 subjective injuries reported
Claims made against 2 insurers
Total value $40,000
Claim links together 3 of the initial 5 policies on network
Fraud Management, Confidential 4

5. 2010 January – Accident 3 Accident 3 Subjective injuries reported
Claims made against 2 insurers
Claim value $224,000
Two clinics link Accident 3 and Accident 2
A claimant and an address link Accident 3 with Accident 1
Now all 5 original policies are linked up on the network
Fraud Management, Confidential 5

6. 2010 July – Accident 4 Accident 4
2 known claims made against same insurer
Value at $14,000
Accident 4 links to accident 1 via an address
Other insurer’s data not available at this time
Fraud Management, Confidential 6

7. 2010 August – Accident 5 Accident 5 Claims made against 2 insurers
Same clinic appears on first and 3rd party claim
Value $410,000
Accident 5 links to Accident 4 and Accident 1 by claimants and addresses
Fraud Management, Confidential 7

8. 2010 August – Accident 6 Accident 6 Occurs 3 days after Accident 5
Links to the network via a claimant
1 known injury claimant
Value $30,000
Fraud Management, Confidential 8

9. 2011 December – Accident 7
Links to network via 2 existing claimants (on accident 1,2 and 5)
6 injuries reported
Forms a ring
Claims made against 2 insurers
Value $125,000
Fraud Management, Confidential 9

10. 2011 December – Accident 8 Accident 8 Occurs 10 days after accident 7
Claimant links to accident 1
Address links to accident 6
1 known injury claimant
Value $23,000
Fraud Management, Confidential 10

11. A second ring developed in parallel2 1
Fraud Management, Confidential 11

12. A third ring developed creating a large network2 1 3 12