INSURANCE FRAUD PREVENTION CHECKLIST

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--- CLAIM SUBMISSION REVIEW ---
[ ] Claim Submission Date
[ ] Claim Number
[ ] Claim Type (Auto, Homeowners, Life, Commercial)
[ ] Narrative Description of Loss
[ ] Policyholder Verification Method (Phone Call, Email, In-person)
[ ] Supporting Documentation (Photos, Police Report)

--- APPLICANT/INSURED BACKGROUND CHECKS ---
[ ] Credit Score
[ ] Criminal Record Check Status (Clear, Minor Offense, Felony, Pending Charges)
[ ] Date of Background Check
[ ] Notes from Background Check Report
[ ] Prior Insurance Claims (select all that apply) (None, Single Claim, Multiple Claims, Denied Claim, Cancelled Policy)
[ ] Copy of Criminal Record Check Report

--- LOSS HISTORY VERIFICATION ---
[ ] Number of Previous Claims
[ ] Date of Previous Claim (Most Recent)
[ ] CLUE Report Accessed? (Yes, No)
[ ] Upload CLUE Report (if accessed)
[ ] MVR (Motor Vehicle Record) Checked? (Yes, No)
[ ] Notes/Comments on Loss History Review

--- WITNESS STATEMENT ANALYSIS ---
[ ] Witness Statement Content
[ ] Statement Consistency (with Police Report/Other Accounts) (Fully Consistent, Mostly Consistent, Somewhat Consistent, Inconsistent)
[ ] Witness Demeanor (Observed) (Cooperative, Evasive, Apprehensive, Calm, Agitated)
[ ] Notes on Witness Behavior
[ ] Relationship to Insured/Claimant (Friend, Family Member, Business Associate, Neutral Party, Unknown)
[ ] Investigator Signature

--- DAMAGE ASSESSMENT VERIFICATION ---
[ ] Estimated Repair Cost (Initial)
[ ] Estimated Repair Cost (Independent Assessment)
[ ] Damage Severity (Minor, Moderate, Severe, Total Loss)
[ ] Photos of Damage (Before)
[ ] Detailed Description of Damage
[ ] Pre-existing Damage Indicated? (Yes, No, Unsure)
[ ] Date of Damage Assessment

--- MEDICAL RECORDS SCRUTINY ---
[ ] Treatment Notes Review
[ ] Number of Visits
[ ] First Date of Treatment
[ ] Primary Diagnosis Consistency (Consistent, Inconsistent, Unable to Determine)
[ ] Billing Code Discrepancies (Unusual Billing Codes, Duplicate Billing, Upcoding, None)
[ ] Attached Scanned Records

--- VEHICLE/PROPERTY INSPECTION ---
[ ] Detailed Description of Vehicle/Property Condition
[ ] Pre-Existing Damage Count (e.g., Scratches, Dents)
[ ] Visible Signs of Tampering? (None, Modified VIN, Altered Mileage, Repaired Damage (Unreported))
[ ] Photographs of Vehicle/Property (Front, Back, Sides, Damage)
[ ] GPS Coordinates of Inspection Location
[ ] Inspection Date
[ ] Inspector Signature

--- POLICY COVERAGE REVIEW ---
[ ] Policy Type (Homeowners, Auto, Commercial Property, Business Interruption, Workers' Compensation)
[ ] Coverage Amount (USD)
[ ] Policy Effective Date
[ ] Deductible Amount (500, 1000, 2500, 5000)
[ ] Review Notes & Comments (e.g., specific endorsements, exclusions)
[ ] Business Interruption Coverage Included? (Yes, No, Unsure)
[ ] Flood Insurance Coverage? ([object Object])

--- DATA ANALYTICS MONITORING ---
[ ] Average Claim Severity (USD)
[ ] Claim Frequency Rate (Claims/100 Policies)
[ ] Loss Ratio
[ ] Fraud Indicators Triggered (Select all that apply) (Unusual Claim Patterns, Suspicious Witness Statements, Unexplained Damage, Inconsistencies in Records)
[ ] Date of Analytics Review
[ ] Summary of Analytics Findings

--- REPORTING & ESCALATION ---
[ ] Summary of Suspicious Activity
[ ] Estimated Fraudulent Value ($)
[ ] Severity Level (Low, Medium, High) (Low, Medium, High)
[ ] Date of Initial Suspicion
[ ] Assigned Investigator
[ ] Notes/Comments for Investigator
[ ] Supporting Documentation (optional)

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