Martin Pieterse, Ellipsys Technologies (Pty) Ltd
It’s no secret that I am a big fan of The Blacklist – Raymond Reddington in a tailored three-piece suit taking down the criminal underworld while building his own empire with the help of the FBI is definitely entertaining and educational.
For those who are not familiar with the NBC series, the very farfetched show follows Raymond “Red” Reddington, the FBI’s most wanted man, who volunteers to work with the FBI to capture other high-profile criminals in exchange for immunity and the opportunity to expand his own empire. Why do I find this series more interesting than the typical crime series, like say CSI?
The Blacklist team’s focus is to prevent crimes from happening rather than solving them after the fact. And this will be the focus for Claims digitisation in 2022. The tools that automation and integration have brought into the Claims space will continue to bring efficiencies to managing the claims processes but the most benefit will be had from:
- Preventing claims; and
- Preventing claims fraud.
Preventing Claims
One of the powerful, and less believable, assets that Reddington brings to the team is his foresight into imminent events. Reddington always knows when an identified target is going to attack/steal/pillage/de-fraud or just annoy a victim next. This foresight would be very useful to know in advance when a claim incident could occur next and avoid the incident in order to minimise claim losses and to improve the overall experience of the policyholders. Where can insurers and administrators find their own Reddingtons to help them predict claim incidents?
Thankfully, access to the Internet of Things (IoT) and other data sources mean you don’t need to employ the services of a criminal.
Smart devices can inform insurers of situations and events that could result in claim incidents allowing the policyholder to be informed to avoid the claim event. Advanced telematics will inform insurers in real-time of inappropriate driver behaviour, like speeding, allowing the insurers to take action before accidents. Smart geysers can warn policyholders of high pressure and leaks allowing the geyser and water supply to be switched off before damage increases.
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Preventing Claims Fraud
Preventing fraud in claims starts long before the actual claims process – at the very first step of engaging with a potential policyholder.
Reddington has a powerful network of informants throughout the underground and they can always be relied on to cough up useful information on a target being pursued.
For the insurers and administrators vetting of the policyholder against fraud databases and verifying the individual’s identity can prevent future fraud by avoiding unwanted policyholders. Looking up a vehicle VIN number against a qualified source and comparing the vehicle details to what is being provided will reduce the number of incorrectly covered vehicles.
Survey photos and application forms stored digitally and accessible at the time of managing the claim will allow the claim technician to compare the item placed undercover to the item being claimed to validate the claim.
Digitally guiding a claimant through the claims process and requesting information as close to real-time as possible from the policyholder can provide information to reduce fraudulent claims. If a policyholder is in a car accident and the insurer is notified of the accident by the telematics system in the car the telematics will record the vehicle details at the time of the accident, including speed, braking information, the direction of travel, etc. The claim can immediately and automatically be created and the policyholder contacted to determine if they need assistance or if the injuries are minor. If the policyholder is able to, they can take photos of the accident scene as guided by their claims app on their phone ensuring all the relevant information is recorded for the claims process and to avoid disputes later. All of this is made possible through advanced telematics, geospatial analytics, data integration and deep learning.
Final Note
2022 will see an increase in the digital capabilities available to insurers and the largest benefits will be gained through preventing claims and reducing claims fraud.