Investigation Procedures & Methods Flashcards

When an Oregon investigator conducts a database search to verify a claimant's prior loss history, which organization's database is MOST commonly used across multiple insurers?

Answer: ISO ClaimSearch

ISO ClaimSearch is the industry-standard database used by insurers nationwide to identify prior claims and detect patterns across companies.

An insured in Oregon submits a property theft claim but cannot produce a police report. The investigator should:

Answer: Request that the insured file a police report and obtain the report number as part of the investigation

A police report is a standard corroborating document; investigators should request it be filed and obtained before drawing conclusions.

Which investigation method involves analyzing financial records to trace the movement of money in a suspected insurance fraud scheme?

Answer: Forensic financial analysis

Forensic financial analysis traces money flows to identify fraudulent transactions, kickbacks, or unexplained income.

In Oregon, when an insurer suspects workers' compensation fraud, the investigator must coordinate with which agency?

Answer: Oregon Workers' Compensation Division (WCD)

The Oregon Workers' Compensation Division oversees workers' comp claims and is the primary agency for coordinating fraud referrals in this line.

A claimant presents receipts for property claimed as stolen that were printed on the same printer model purchased after the loss date. This is BEST described as:

Answer: Evidence of post-loss fabrication of proof of ownership

Receipts produced after the loss date on equipment the claimant did not own at the time of loss indicate fabricated documentation.

Which of the following best describes 'soft fraud' in the context of Oregon insurance investigations?

Answer: Exaggerating the extent of a legitimate claim to receive higher payment

Soft fraud involves inflating or padding an otherwise legitimate claim, as opposed to hard fraud where the entire loss is fabricated.

When reviewing surveillance footage as part of an Oregon investigation, the investigator should FIRST:

Answer: Document the chain of custody and preserve the original footage unaltered

Preserving the original footage with a documented chain of custody ensures it remains admissible and legally defensible.