Fraud investigations

Quantumcorp’s fraud investigations team, established in 2006, works with large insurers, niche insurers, claims management organisations and lawyers to quickly identify relevant facts, inconsistencies, anomalies and other fraud-related elements.

We have an exceptional track record of success over many thousands of investigations. Our work allows clients to make sound, evidence-based determinations, and results in significant savings for insurers.

Every Quantumcorp fraud investigation is completed by a highly-trained investigator, following our ‘fraud triangle’ investigation model:

Investigators are trained in how to investigate each of these key issues, using our in-house training manual, which includes explanations, sample questions, mock scenarios, tips, and checklists to ensure each issue is thoroughly and correctly investigated.

 

Investigation planning

All Quantumcorp investigation personnel are thoroughly trained in investigation planning to deliver timely cost-effective results for clients.

For each investigation plan, Quantumcorp:

  • identifies relevant issues for investigation or enquiry
  • identifies stakeholders (insured, material witnesses, peripheral witnesses, experts)
  • determines the type of evidence required from each party (e.g. audio taped interview, record of conversation, telephone interview)
  • plans field enquiries to suit time frames
  • plans for efficient and targeted investigations, with no long lag time between enquiries and no investigation of irrelevant issues.

Our clear and detailed investigation plans provide a comprehensive map of each investigation to ensure smooth and timely management of each case.

 

Evidence gathering

Quantumcorp personnel are thoroughly trained in best practice investigation and evidence gathering around the key issues in fraud investigations.

Our bespoke training programme clearly defines the investigation process and evidence gathering techniques.

Real life examples and role play scenarios ensure each investigator is equipped to collect relevant, accurate and detailed evidence to support sound decision making.

 

Witness categorisation

To appropriately collect relevant information, Quantumcorp applies a tried and tested witness categorisation model to identify witnesses and ensure that:

  • appropriate and thorough enquiries are made of each witness
  • we appropriately record and collect witness evidence
  • evidence stands up to scrutiny by the Financial Ombudsman Service, should a claim decision be appealed.

 

Best practice

Quantumcorp’s comprehensive training manual and induction process ensures all investigators comply with principles of procedural fairness and industry standards.

To deliver procedural fairness, we:

  • train all investigators to impartially assess and investigate each claim, statement and piece of evidence to establish the facts of the matter, irrespective of what those facts may show or their opinion of what this might mean
  • provide each insured the opportunity to receive and respond to adverse information gathered during the course of an investigation – issues requiring a response may include credibility issues or the findings of expert witnesses (such as forensic locksmiths, accident reconstruction experts and/or forensic fire investigators)
  • accurately record and report to the insurer any responses from the insured to be considered prior to the insurer reaching a decision
  • follow rules of evidence in collection of evidence and ensure accurate and detailed recording and reporting
  • complete further enquiries, where appropriate, into evidence in dispute.

To ensure all stakeholders are treated equitable and fairly, we:

  • make initial contact by phone with a friendly introduction
  • send an introductory letter to each interviewee to formalise and explain Quantumcorp’s role, and request the interviewee collect basic documents for our review
  • provide website references and links to more information about investigation procedures and appropriate standards
  • invite the interviewee to have a support person present
  • organise an interpreter for interviewees who require one
  • only ever interview children in the presence of a parent or guardian
  • always explain the reasons for interview and detail the process with absolute clarity
  • pause the interview any time the interviewee becomes distressed, and continue only when the interviewee is ready
  • manage each interview professionally, and handle difficult situations sensitively.

The experience, qualifications and training of Quantumcorp’s team significantly reduces the risk of complaints, and allows clients to make evidence-based decisions with confidence.

 

Reporting

Clear templates and quality review points ensure each report from Quantumcorp is clear and concise, and provides all relevant information for clients and their lawyers to make sound decisions.

Quantumcorp provides weekly progress reports to clients – a single page case summary of all investigation activities completed to that point – so that clients can stay on top of the investigation’s progress.