Premium Fraud / Signal 02

Misclassification

Employees or operations may be reported under classifications that do not reflect the actual work performed.

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Questions to Answer

Define the representation before choosing the investigation.

What duties were actually performed during the relevant policy period?

Where was the work performed and under whose direction?

Do licenses, permits, contracts, job postings, websites, or project records corroborate higher-risk operations?

Evidence to Develop

Build the factual chain from independent sources.

Job duties

Employee statements, job descriptions, supervisor information, task and project records.

Business footprint

Website content, advertising, social/business profiles, licenses and permits.

Project evidence

Contracts, invoices, job-site photos, equipment, fleet, and customer-facing descriptions.

Classification comparison

Compare supported duties and operations with applicable classification rules; obtain specialist input where needed.

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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