Insurance and Fraud Investigations in Hong Kong

Insurance and Fraud Investigations in Hong Kong

Suzzess Hong Kong regularly handle insurance fraud investigations to prove 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. Our investigators will also be available to provide witness statements, if required. Fraud and corruption represent a real risk for every organization. Suzzess is regularly called upon to provide fraud, corruption and misconduct investigations. Until a thorough investigation is conducted, it is often not known whether the basis of an allegation represents possible fraud, corruption or other serious misconduct such as a breach of duties, regulations, policy or guidelines.

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

1. Responding to a complaint – upon receipt of a complaint from a client, full details needs 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. 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. 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 interests also need to be checked.


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


5. 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. 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 offenses.

Suzzess has handled many insurance related investigations including surveillance and monitoring of suspects claiming personal inquiries, Employees’ Compensation Claims etc. Other insurance related matters relate to death verifications in Hong Kong, China and Taiwan.

To book your consultation for a fraud investigation in Hong Kong, or if you have any questions, fill out an online enquiry form here.