CRIF helps PI insurers and compensators to navigate the changing regulatory landscape

CRIF Decision Solutions has developed Sherlock Alert to proactively and directly notify an insurer or compensator’s fraud prevention team of a suspicious personal injury [PI] claim warranting further investigation. 

Designed with client input and following proof of concepts with leading UK insurers and compensators, Sherlock Alert supports users in navigating the changing regulatory landscape for PI claims and the requirement to gather evidence and consider their position on fault within 30 business days. 

Sherlock Alert uses the information exchanged between an insurer/compensator and the Compensation Recovery Unit [CRU] combined with data sources from CRIF’s ID verification tool, to automatically detect when the claimant’s National Insurance Number [Nino] may have been altered to commit fraud.  The accuracy that comes from checking actual Ninos, rather than algorithms is game changing and unique to Sherlock Alert.  CRIF led insurer/compensator pilots which have proved the correlation between Nino mismatches and PI claims fraud.  Pilot results showed that 5% of submitted PI claims had a Nino mismatch; of those, 20% were classified as suspect following ID verification checks; and following further investigation 70% were proven to be fraudulent.  The potential claims fraud savings make a compelling business case and guarantee significant ROI on the annual licence fee cost of Sherlock Alert; especially as it comes as a plug and play tool with no IT cost impact.

Sherlock Alert is an extension to Sherlock Investigation, CRIF’s counter fraud solution currently used by around 100 insurers.  Automatically notifying the fraud prevention
team by alert removes any ‘overlook risk’ arising from reliance on manual notification by the claims handler.  Valuable time is also saved, enabling the investigation process to start swiftly.  One click from the fraud investigator can start a claim enquiry with Sherlock Alert providing pre-populated forms and the ability to easily export data to the insurer/compensator’s internal platforms.  Added value is also gained from the ID verification supporting ‘Know Your Customer’ requirements. 

Sara Costantini, Director at CRIF Decision Solutions said: “CRIF has been developing fraud prevention tools for over 20 years and our success comes from identifying, merging and leveraging new and existing data sources in innovative ways to help insurers and compensators keep one step ahead of the fraudsters.  The market is facing challenging times with new types of fraud, like claims farming and identity theft, and we listened to clients’ needs and designed Sherlock Alert with their input.  The concept has been warmly welcomed and our R&D team are now busy looking at additional data sets and alert subjects which will bring extended value to our insurer and compensator client community and the wider market.”