Fraud &Investigation
Effective investigation extends far beyond fraud alone and is fundamental to achieving fair, evidence-based outcomes across all claim types and perils.
Effective investigation extends far beyond fraud alone and is fundamental to achieving fair, evidence-based outcomes across all claim types and perils. It relies on a broad set of professional skills, including evidence gathering and evaluation, critical analysis and interviewing. As claims become increasingly complex and customer expectations continue to rise, the importance of robust investigative practice has never been greater.
The CILA Fraud & Investigation SIG committee brings together experienced claims and insurance professionals with a shared focus on fraud prevention, detection and mitigation, as well as investigation as a core professional discipline. The group promotes best practice and professional standards across the industry by sharing knowledge, technical insight and practical experience drawn from a wide range of investigative work.
Through thought leadership, practical guidance and professional development opportunities, the group supports members in strengthening both fraud-related expertise and wider investigative competencies. It also contributes to wider industry discussions, helping to advance evidential integrity, customer outcomes and technical excellence across the claims profession.
SIG Committee
Chair
Bobby Gracey
Charles Taylor Adjusting
Vice Chair
Garry Slater
AED Group
Members
Steven Crystal
Sedgwick International UK
Neil Daniel
Harris Balcombe
Brendan Gillooly
McLarens
Nicole Lawrence
Sedgwick International UK
Chris Lee
Crawford & Company
David McLaughlin
Woodgate & Clark
Kevin Reid
Sedgwick International UK
Latest updates
SIG Update: Introducing the Fraud & Investigation SIG
We are pleased to announce that the Anti-Fraud Special Interest Group (SIG) has been renamed the Fraud & Investigation SIG.
This change reflects both the breadth of expertise within the group and the evolving demands of the insurance and claims professions. While fraud prevention, detection and mitigation remain central to our purpose, the revised name recognises that effective investigation extends far beyond fraud alone and is fundamental to achieving fair, evidence-based outcomes across all claim types and perils.
Read the full article here to learn more about the reasons behind the change and what it means for the future direction of the SIG.
Simplifying the complexity of international claims investigations
In this paper, Bobby Gracey and Simon Cook explore the complexities of international claims investigations, highlighting key challenges such as navigating diverse legal frameworks and managing cultural and logistical barriers. They also examine emerging trends, including the growing role of AI in both facilitating and detecting fraud, alongside real-world case studies that demonstrate how these issues play out in practice.
Fraud & Property Claims
Anti-Fraud SIG Webinar – ‘Fraud and Property Claims’
On Wednesday 1st and 8th March, Neal Davies-Fletcher delivered a 2-part webinar entitled ‘Fraud and Property Claims’ which was attended by over 100 CILA members worldwide. Both webinars covered fraud aspects of the CILA Advanced Diploma syllabus including:
- What is fraud?
- Claims investigation
- Standard of proof
- Investigation outcomes
- Remedies available
Please find copies of both presentations below, as well as an Anti-Fraud paper written by Neal,
to aid exam candidates with their revision.
Downloads
Fraud and Property Claims Presentation (Part 1) (1.91 MB)
Fraud and Property Claims Presentation (Part 2) (1.86 MB)
Fraud and Property Claims Paper – Neal Davies-Fletcher (1.86 MB)
Commercial fraud awareness
Fraud investigators from the CILA Anti-Fraud SIG committee discuss the financial impact of covid-19 on businesses and how this may lead to commercial insurance fraud.
The paper considers fraud statistics, the UK economy and the challenges for businesses. The writers use real life examples to demonstrate how a business may exaggerate or fabricate an insurance claim. They also provide some insight into the types of action that can be taken to combat fraud and the important role that claims handlers and loss adjusters have.
Anti Fraud Survey 2013 - Results Analysis
This report provides the results analysis of the Anti Fraud member survey 2013
Technical Bulletin 38 - Data Protection Act 1998: Section 56
The Data Protection Act 1998 (DPA) is based around eight principles of good information handling. These give everyone specific rights in relation to their own personal information and place obligations on those organisations that are responsible for processing it.
A criminal offence is created under section 56 of the DPA, commonly known as ‘enforced subject access’. This will occur where a person wishes and requests to see another individual’s criminal record, but chooses not to use the legally approved system.
Downloads
Searching for SIG material?
Have a look in the CILA Technical library. Papers and presentations that were previously produced by our SIGs are often filed there for the benefit of members.