| InsureMax
Insurance Company Fraud Prevention
InsureMax Insurance Company recognizes that insurance
fraud exists in the insurance industry. As such, it is the policy and
mission of the Company to strive to protect its customers and shareholders
through the employment of an effective and diligent Anti-Fraud Plan.
In addition, the Company recognizes its responsibility
to identify, evaluate and resolve questionable activity involving an
employee or agent of the Company. This purpose and mission protects
corporate assets from losses relating to theft, embezzlement and other
questionable financial business practices.
The Company will work to foster open communication
and support for other fraud control entities such as federal, state,
and local law enforcement, state fraud bureaus and the National Insurance
Crime Bureau.
Anti-Fraud Plan
The purpose and goal of our Anti-Fraud
Plan is to educate, detect, investigate and deter insurance fraud thereby
reducing insurance costs.
Anti-Fraud Strategies
As part of the Company's management process, the InsureMax
Insurance Company's claim staff will endeavor to thoroughly review each
claim and identify those claims exhibiting fraud related indications,
red flag events and situations or behavior indicative of fraud schemes.
As such, the Company's claim staff will act as the first phase in detecting
questionable claims and will refer them to the appropriate investigative
unit for further analysis. The investigative unit will also act in an
advisory capacity to the underwriting department.
Special investigations will include the application of
techniques and resources to resolve fraud issues. Investigative results
are used to decide which course of action is warranted. Recommendations
may include claim payment, claim reduction, claim denial or opportunity
to withdraw claim, or the pursuit of restitution if the claim was paid,
and possible law enforcement referral.
Special Investigation Unit (S.I.U.)
The Company has an S.I.U. composed of a four person anti-fraud
review committee responsible for review, reporting, and the appropriate
resolution of all suspected fraudulent insurance acts.
Position
Insurance Fraud will not be condoned by InsureMax Insurance
Company. Our personnel are dedicated to the prevention of insurance
fraud and will aggressively review, analyze, monitor, investigate and
prosecute to the fullest extent of the law fraudulent insurance acts.
It is our position that the validity of such acts will receive the benefit
of the doubt unless proven otherwise through complete investigation
and evaluation toward their appropriate disposition. These acts in general
are, but not limited to:
- Application Fraud
- Certificate of Insurance Fraud
- Fraudulent Insurance Claims
- Understating Rating Exposures such as Sales, Payroll, etc.
Further, we will comply with state statutes with
respect to the reporting, investigation and preparation of Anti-Fraud
Plans.
Reporting
Suspected fraudulent insurance acts must be reported
to the respective State Fraud Bureau where applicable. Those acts involving
InsureMax Insurance Company should be referred to the company using
the sample referral form.
All suspected fraudulent insurance act referrals
including supporting documentation should be forwarded to "Compliance
Officer", InsureMax Insurance Company, 4976 State Road 261, Newburgh,
IN 47630.
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