Insurance Claims and Fraud Investigations in Hong Kong

Insurance Claims and Fraud Investigations

Suzzess Hong Kong regularly handles insurance fraud investigations to prove the submission of fraudulent claims. For a claim that is dishonest or fraudulent, hard evidence is needed and Suzzess is in the position to undertake a discreet but thorough fraud investigation, involving a mix of intelligence and surveillance to meet the objectives.

The Importance of Insurance Claims and Fraud Investigations

Insurance claims and fraud investigations are crucial for protecting the integrity of insurance systems and ensuring fair compensation for legitimate claims. Uncovering fraudulent activities helps maintain the trust and reliability of insurance processes, safeguarding the interests of both insurance providers and policyholders and avoiding substantial financial losses.

Our Comprehensive Strategy to Conduct Insurance /Fraud Investigations

Each and every investigation is different. As such, there are no hard and fast rules on how to investigate false insurance claims or conduct fraud investigations in Hong Kong. Differences in the accessibility of data, geographical location, available techniques, evidence rules, etc. – all play a role in the procedures. From a case manager's perspective, the following steps need to be noted:

1. Responding to a complaint

   Upon receipt of a complaint from a client, full details need to be obtained either directly, or via the client's representative, which will usually be a lawyer. An experienced investigator will request full particulars and indicators as to why fraud is suspected and will obtain a general picture of the circumstances.



2. Evaluating allegations or suspicions of fraud/ bogus insurance claims

   Upon obtaining preliminary information, an assessment is required by the investigator to evaluate the allegations or suspicions of fraud and to decide whether there is enough to justify a fraud investigation. The last thing we want is to take on a case where it is subsequently found to be time consuming, disruptive and costly.



3. Conducting preliminary assessments

   Preliminary assessment of Subject under fraud investigation. Does the Subject have previous a history of fraud? Is he/she a known criminal? Any political affiliations etc. At this stage, possible conflicts of interest also need to be checked.



4. Opening the case

   Case opening and collection of documentation from the client. A systematic approach is required, including assigning case managers, delegating work, scheduling deadlines, budgeting, etc.



5. Collecting evidence and documents

   Field inquiries, desktop research, proprietary database checks, source inquiries and interviews with sources and witnesses. All of the above may be conducted overtly or discreetly.



6. Reporting the findings

   Consolidation of inquiries in a full written report. Decide what action is best for the client and make recommendations based on the results of the investigation – an administrative sanction or criminal referral, for example – and prepare a concise final report, organized according to the elements of proof for the relevant fraudulent offenses.

Contact Us and Protect Your Business Today with Fraud Investigation and Our Other Services

Suzzess has extensive experience in handling many insurance claims and fraud-related investigations, including surveillance and monitoring of suspects claiming personal inquiries, Employees' Compensation Claims, etc. Other insurance-related matters also include death verifications in Hong Kong, China, and Taiwan.

Outside of insurance claims and fraud investigations, our array of expertise and services also incorporates corporate investigation, intellectual property investigation, pre-employment screening, due diligence checks, and background checks in Hong Kong and beyond. To book your consultation for a fraud investigation or any other form of private investigation in Hong Kong, or if you have any questions, fill out an online enquiry form here.