Premium Fraud / Signal 03

Hidden operations

Public and business evidence may indicate operations not reflected in the stated policy exposure.

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Questions to Answer

Define the representation before choosing the investigation.

What operations were represented at application/audit?

What additional work is suggested by independent sources?

Was the activity performed by employees, contractors, a related entity, or another business?

Evidence to Develop

Build the factual chain from independent sources.

Open-source business research

Websites, reviews, directories, social/business pages, archived pages and advertisements.

Permits & licensing

Building permits, contractor licenses, professional licenses, registrations.

Job-site intelligence

Project locations, equipment, vehicles, branded assets, customer/project records.

Entity relationships

Related businesses, DBAs, common addresses, officers, ownership, phone numbers and websites.

Next Step

Document what the evidence says - and what it does not.

Record the fact, source, date, relevance, and unresolved questions separately. Where the issue involves classification rules, rating, law, policy interpretation, or criminal referral standards, involve the appropriate specialists rather than asking the investigation to make the legal conclusion.

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