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The Special Investigative Unit  

https://zalma.com/blog

California, Washington, New Jersey, and Florida are among many states  that require each insurer to have an SIU in place.  SIUs help identify  and investigate suspicious claims, although some insurance companies  outsource this work to other insurers and investigative agencies. An SIU  may be a small team whose primary role is to train claim  representatives to deal with the more routine kinds of fraud cases or  may consist of teams of trained investigators, including former law  enforcement officers, attorneys, accountants, and claim experts who work  together to investigate fraudulent activities thoroughly. More complex  cases, involving large-scale criminal operations or individuals who  repeatedly stage accidents, may be turned over to the NICB.  In some cases, the SIU has grown to be a multifaceted organization whose  duties are not limited to the investigation of fraudulent claims.  Depending on the way it is organized, the SIU\\u2019s work as an integral part  of an anti-fraud program that includes the following:  * investigation of potentially fraudulent claims; * education of claims and underwriting personnel about how to recognize  potential fraud; * education of the public about how insurance fraud affects the average   insurance buyer; and * liaison with fraud division, police, and prosecutorial agencies.   

The CFE  The Certified Fraud Examiner (CFE) is a fraud-fighting professional.   The Association of Certified Fraud Examiners is an international,  25,000-member professional organization dedicated to fighting fraud and  white-collar crime.  It was established in 1988, and is based in Austin,  Texas.  With offices in North America and chapters around the globe,  the Association is networked to respond to the needs of anti-fraud  professionals everywhere.  

The Expert Attorney  When an insurer suspects fraud, it will usually ask an attorney to get  involved.  Attorneys who are retained in such situations are specialists  who have either received specialized training or have sufficient  experience concerning fraud and the evidence necessary to prove fraud to  handle these cases.  Many are CFEs and all make it a practice to attend  continuing education classes that relate to fraud issues.  The role of the expert attorney varies depending on the type of claim  where fraud is suspected.