A critical step for everyone investigating insurance fraud

How’s this for a proposal? It should be mandatory for everyone involved in the investigation of insurance fraud to pass a course in philosophy; more particularly, a course in that part of philosophy called logical reasoning, or to give its more modern name, critical thinking.

So how can critical thinking help those involved in what is often seen as the front line of claims assessment? Well, it would ensure that the reasoning upon which potential fraud cases are decided is clear, consistent and inherently sound. That’s because courses in critical thinking teach you how to evaluate the various strands of a case systematically and (there’s no better word for it) logically.

Claims whose fraud markers stand up to the rigours of critical thinking can be directed to the Insurance Fraud Register, while those which don’t can be returned to the normal assessment process. Critical thinking helps to cut out loose, incomplete and self interested thinking, of the sort that will haunt fraud managers interested in maintaining the quality and integrity of their work.

So why not just make training in critical thinking optional for those interested? For three reasons: firstly, you’re only as good as your weakest link, and secondly, the impact of many fraud decisions will be enormous – we’re talking of no access to insurance and unable to drive, get a mortgage or some types of job. Thirdly, insurers have taken on the role of police, judge and jury – such a concentration of power needs to be balanced with a matching commitment, in the public’s interest, to the highest quality of process.

One category of claim that those interested in critical thinking need to keep an eye on is the walk-away claimant. These involve the claimant giving up on a claim part way through. This is a characteristic of fraudsters who find themselves too close to detection. However critical thinking will tell you that while all unsuccessful fraudsters walk away, this does not mean that all those who walk away are fraudsters. Most insurers seem now to have grasped this, but it is clear that doubts still linger in places. The great danger is that doubts like this could resurface elsewhere and undermine the soundness of claims fraud decision making.

What fraud managers fear is some dodgy reasoning leading to an influential person being put on the Insurance Fraud Register and then going very public about the highly uncritical thinking that brought this about. It reminds me of a meeting in which a senior figure in the City of London made clear that his final card, should a serious and unexpected impasse in critical negotiations with a big insurer end unresolved, would be to “bring the sky down on them”. The matter was of significant public interest and was personal enough for him to consider playing in his many connections, in and out of business. Everyone there was relieved to be on his side of the fence.

A course or two in critical thinking would be incredibly cheap in comparison. And yes, I have taken just such a course, for a year while at university. It was great fun!