Undetected Fraud Inflating Settlement Amounts

$1,200,000 to $1,800,000 annually (15-20% of Lloyd's medical claims leakage per typical syndicate) • $1,600,000 to $2,400,000 annually (15-20% of reinsurance claims leakage; compounded by time-value of recovered funds and legal costs) • $1,800,000 to $2,400,000 annually (15-20% of reinsurance claims leakage; compounded by inability to recoup from primary insurers)

Claims adjusters manually flag suspected fraud; retrospective SIU (Special Investigation Unit) review; post-audit loss adjustments • Claims file review by Lloyd's auditors; manual feedback to managing agents; subjective reserve adjustments at year-end • Manual case-by-case review of treatment narratives; Email threads between reviewers; Spreadsheet tracking of flagged claims; Memory-based pattern matching; Phone calls to verify suspicious providers