SIU & Fraud

Develop the facts without predetermining the conclusion.

A practical topic center for turning indicators into defined investigative questions, testing competing explanations, corroborating material facts, and documenting findings that claims and SIU professionals can actually use.

Investigation Framework

A red flag is a reason to ask a better question.

Indicators may justify inquiry, but they are not proof. The investigative record should separate known facts, unverified information, hypotheses, corroboration, and unresolved issues.

1Define the concernState the specific representation, conduct, inconsistency, or claim issue that requires factual development.
2Identify materialityConnect the question to a legitimate claims, policy, SIU, underwriting, or legal decision without assuming the outcome.
3Map the sourcesIdentify records, witnesses, public information, physical evidence, and other lawful sources that could confirm or refute the concern.
4CorroborateTest important information against independent sources and document conflicts rather than forcing them into one narrative.
5Report proportionatelyDescribe what the evidence supports, what it does not establish, and what remains unresolved.
Common Development Areas

Build the evidence around the issue.

Identity & Relationships

Who is connected to whom?

Develop verified identities, addresses, employers, businesses, ownership, affiliations, and relevant relationships when they bear on the investigative question.

Potential sources: records · interviews · lawful OSINT · business filings
Representations

What exactly was said or reported?

Identify the precise statement, time period, source, and context before evaluating whether evidence is consistent or inconsistent with it.

Potential sources: claim file · statements · forms · correspondence · records
Activity & Operations

What was actually happening?

Develop work activity, business operations, locations, schedules, transactions, or other observable facts relevant to the issue.

Potential sources: witnesses · public records · field observations · business records
Chronology

When did the material events occur?

Build a source-based timeline so contradictions, gaps, and causal relationships can be evaluated in context.

Potential sources: dated records · communications · statements · incident material
FIELD NOTE

Follow the Work, Not Just the Worker

Use work-related locations, business activity, and operational facts to develop questions rather than assumptions.

Read Field Note →
FIELD TOOL

Recorded Statement Preparation Guide

Organize the objective, chronology, fact gaps, questions, and corroboration leads before the interview.

Download guide →
QUALITY CONTROL

Investigation Report Review Checklist

Test whether the work is objective, traceable, complete, and responsive to the assignment.

Download checklist →
Field Principle

Investigate the question. Do not investigate toward a verdict.

The strongest SIU work develops evidence that can support or refute the original concern. Fraud determinations, coverage decisions, legal conclusions, and regulatory referrals remain with the professionals authorized to make them.

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