Insurance runs on trust. A policyholder declares their health, their income, their business and their losses, and the insurer pays on that basis. Most of the time the trust is justified. When it is not, the cost falls on every honest customer through higher premiums, and on the insurer through losses, reserve pressure and regulatory scrutiny.
Our insurance fraud investigation services help life, health and general insurers, reinsurers, takaful operators, third-party administrators and loss adjusters separate genuine claims from false ones. As an international investigation firm headquartered in Dubai and backed by the 30+ years of GREVESGROUP®, we verify claims and policyholders in more than 100 countries, including the markets where cross-border fraud is hardest to detect.
Investigation Challenges for Insurers
The insurance sector faces fraud at every stage of the policy lifecycle:
- At proposal stageNon-disclosure of illness, false income or occupation, and identity fraud
- During the policyAgents or brokers colluding with customers, or policies bought shortly before a planned claim
- At claim stageFabricated deaths, staged accidents, phantom hospital treatment, inflated property losses and false cargo claims
- After settlementMissed recovery and subrogation opportunities against liable third parties
Cross-border claims add another layer. When the death, accident or treatment happens in a different country, the claims team loses its usual verification tools, and fraudsters know it.
Insurance Fraud Red Flags We Investigate
Claims teams refer cases to us when they see warning signs such as:
- A claim soon after policy inception or a recent increase in cover
- Several policies with different insurers on the same life or asset
- Death, injury or loss reported in a country with weak record-keeping
- Medical documents from providers with a history of disputed bills
- Claimants, witnesses and repairers sharing addresses, phones or bank accounts
- Losses that do not match the insured's known income, stock or business activity
- Pressure for fast settlement combined with reluctance to allow verification
One red flag rarely proves fraud. A focused investigation answers the question quickly, either way.
Our Investigation Services for Insurers
Claim Investigation
Our core service for the sector. Our claims investigation company verifies life, health, motor, property, fire, marine, liability and disability claims through document checks, hospital and registry verification, scene visits and lawful interviews. Death claim verification abroad is a specialism, covering hospitals, civil registries, burial or cremation records, police and community sources in the country where the death was reported.
Background Check
Fraud often starts with a false proposal. Our pre-issuance verification confirms identity, income, occupation, address and declared health status for high-value life and health policies. We also run background checks on agents, brokers, garages, hospitals and other partners joining your network.
Corporate Investigation
When agents, brokers, staff or service providers collude with claimants, our corporate investigators look at the network behind the claims: shared addresses, phone numbers, bank accounts and relationships. These organised insurance fraud investigations often reveal patterns across many claims rather than one.
Due Diligence
Before appointing a TPA, broker, bancassurance partner or reinsurance counterparty, our due diligence verifies ownership, management, reputation, litigation and regulatory history. For large commercial risks, we can also investigate the insured business before cover is written.
Private Investigation
Where lawful and proportionate, our investigators conduct activity checks on disability, injury and income protection claimants to verify whether the claimed limitations are genuine. We never carry out personal or domestic surveillance.
Process Service
Recovery and subrogation actions often involve defendants in other countries. Our process servers handle personal and Hague Convention service of claims and judgments, with court-ready proof of service.
IP Investigation
Insurers are increasingly impersonated by fake policy sellers and fraudulent claims portals. We investigate misuse of insurer names and trademarks and identify the people behind them.
Brand Protection
Fake insurance agents, cloned websites and fraudulent WhatsApp and social media sellers damage policyholder trust. Our brand protection team detects impersonation, traces the operators and supports takedown and legal action.
Recovery and Subrogation Support
When a claim has been paid because of a third party's fault, recovery depends on finding assets. Our subrogation asset searches identify the liable party's property, business interests and other assets, and our investigators trace defendants who have moved. This turns paper recovery rights into real recoveries.
Typical Engagements
The scenarios below are illustrative examples of the kind of work we carry out in this sector.
Death claim abroad
A life insurer receives a claim for a policyholder who reportedly died during a visit to his home country, two years into a large policy. Our investigators visit the hospital, check the civil register and speak to local sources. The hospital has no admission record and the registry entry was made on the basis of a forged certificate. The claim is repudiated with full evidence.
Hospital billing pattern
A health insurer notices a spike in claims from one clinic. We verify a sample of admissions, interview patients and check billing records. Several patients confirm they received outpatient care only, while the clinic billed for inpatient stays. The insurer uses the findings to recover overpayments and remove the provider from its network.
Genuine claim, fast
A marine insurer receives a large cargo claim with incomplete documents from a distant port. Our investigators confirm loading, transit and the incident with the port, surveyors and carriers. The claim is genuine, and the insurer settles quickly with confidence.
What You Receive
Each claim report gives a clear finding on every point you asked us to verify: confirmed, not confirmed or contradicted. Copies of records, photographs of locations visited, interview notes or statements and a summary of inconsistencies are attached, so the file supports your decision if it is later challenged.
How We Work with Insurers
We work as an extension of your claims team or special investigation unit. Referrals can be made case by case or through a panel arrangement with agreed service levels, reporting formats and fee schedules. Each report gives a clear finding on every verification point you raise, with evidence attached, so your claims committee can decide without delay.
Why Insurers Choose Risk Investigators
Local verification worldwide
In-country investigators check records at the source in more than 100 countries.
Objective findings
Genuine claims are confirmed as quickly as fraudulent ones are exposed.
Pattern recognition
Around 1,000 cases a year across the group means we recognise common fraud schemes quickly.
Fair process
Lawful methods and documented evidence that stand up to complaints, ombudsman review and litigation.
Flexible engagement
Single referrals, panel arrangements or portfolio reviews, depending on how your claims operation works.
Frequently Asked Questions
What does an insurance fraud investigator do?
An insurance fraud investigator verifies the facts behind a claim or policy. The work includes document checks, hospital and registry verification, field visits, interviews and background research, followed by a report on whether the claim is genuine, exaggerated or fraudulent.
Can you verify a death claim in another country?
Yes. We verify deaths abroad through hospitals, civil registries, burial or cremation records, police and local sources in the country where the death was reported.
Do you work with takaful operators?
Yes. We investigate family and general takaful claims and conduct proposal verification in the same way as for conventional insurers.
Can you investigate organised insurance fraud rings?
Yes. We analyse links between claimants, agents, garages, hospitals and service providers to identify networks behind repeated or connected claims.
Do you offer panel arrangements for insurers?
Yes. We can work on a case-by-case basis or under a panel agreement with agreed turnaround expectations, report formats and fees.
How do you handle claims where fraud is not proven?
We report the facts objectively. Where the evidence confirms the claim, we say so clearly, so the insurer can settle promptly. Where findings are inconclusive, we explain what was verified, what was not and why.
Can you verify policyholder information before a policy is issued?
Yes. Our pre-issuance checks verify identity, income, occupation, address and declared health status for high-value policies, which reduces early claims and non-disclosure disputes.
Do you investigate cargo and marine claims?
Yes. We verify loading, transit, discharge and delivery with ports, surveyors, carriers and warehouses, and investigate theft, shortage, damage and document fraud for cargo insurers and P&I interests.