Pet insurance fraud can be eliminated with smart data

Pet insurance fraud can be eliminated with smart data

Aug 03, 2015

In the wake of the conclusion of latest pet fraud case to come before the courts, bosses at Anglo-American Aquarium Software are pointing out that modern specialist software already exists that can help pet insurers detect unusual claims activity, and automatically flag potential fraud cases.

The comments come as a married couple from Sheffield who defrauded an insurer out of £8,358.50 by making fictitious claims for real and non-existent dogs between 2013 and 2014. Mr and Mrs Stafford received suspended sentences after their insurer identified their claims as fraudulent and referred them to the City of London Police’s Insurance Fraud Enforcement Department.

“This case is just one in a growing number showing the extraordinary lengths some people will go to in order to commit fraud,” said Mark Colonnese, Sales and Marketing Director at Aquarium. “While the case is good news as it shows the police working in tandem with the industry, the tools do exist to identify the criminals who increase insurer costs and push up premiums for everyone. Pet insurance fraud should not be allowed to happen in the first place, and there’s no reason why it should. The number of recent cases suggests that the adoption of anti-fraud intelligent software can’t happen soon enough. These people were caught, but how many are slipping through the net?”

Fraudulent pet insurance claims rose by 65% to a record £1.2million last year according to the Association of British Insurers (ABI). The actual number of fraudulent claims increased by 16% leading many to question why more is not being done by pet insurers to prevent this activity. Aquarium specialises in designing bespoke technology platforms for pet insurers; the same processes designed to deliver better pet care and an enhanced customer journey can also be used to detect fraud.

“The pet insurance market is growing as pet owners realise the benefits of insurance, but this is also going to attract the unscrupulous,” added Mark. “Ultimately cases of fraud can lead to increased premiums for honest customers but with the right technology and the sort of partnerships and cooperation with law enforcement agencies as seen in this case, we can send out the message that fraudsters are going to get their collars felt sooner than they might imagine.”   

Aquarium software is tailor made to help prevent the fraudulent exploitation of insurers. Having already been deployed in the UK and America, the technology is proving its worth in detecting fraudulent activity as well as improving the efficiency of the claims processes. Aquarium specialises in improving the effectiveness of the entire process from the initial quote through to policy administration and claims management.

The Stafford’s were able to exploit Chelsea’s accountancy experience to make forged invoices from a local veterinary practice to the insurer seem authentic. While ultimately being caught, this was not before they had been sent an initial payout. From an Aquarium and an industry standpoint, it is desirable to nip such claims in the bud before they ever reach the point of a cheque being issued.

“The Aquarium platform has the ability to link to veterinary records and claims history in a seamless manner and carrying out checks using processes such as management by exception, which means those working on a case see only the pertinent information,” added Mark. “Such systems very quickly highlight discrepancies such as invoices that are non-standard. Our software is used to assess pets according not only to individual medical history but the medical issues faced by the breed in general. This can quickly flag areas of concern – particularly when there is a failure to use the correct medical terminology as in this case.”

Aquarium’s powerful MI delivers a full profile about the claim/(s) the owner and the pet/(s) concerned. In this case, the Stafford’s phoney letters employed poor grammar and it was this coupled with the incorrect medical terminology that led to an investigation. One letter claimed their dog Buster had suffered an ‘airline fracture’ to his leg – which led to him getting cancer and dying. However, Buster was alive and well when police arrested Chelsea, despite her claiming she was in fact called Kelsea Stubbins.