Score an insurance claim for fraud red flags — timing anomalies, inflated values, prior claim history, witness absence, weekend incidents. Get risk rating and fraud reporting channels for your country.
🚨 Fraud Detection📋 Red Flags⚖️ Risk Rating
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Claim Details
⏰ Timing & Circumstances (25 pts)
Incident occurred within 3 months of policy start date
Incident occurred on weekend, public holiday, or at unusual hours (midnight–5am)
Claimant experienced recent financial hardship (job loss, business failure, bankruptcy)
Claimant delayed reporting incident to police/insurer by 48+ hours
💰 Claim Value Indicators (25 pts)
Claim amount exceeds 75% of policy limit (possible sum-insured inflation)
Claim-to-premium ratio is >10:1 (e.g., claim ₦5M on ₦200k annual premium in year 1)
Supporting documents (receipts, valuations) appear altered, printed recently, or are inconsistent
📜 Claim History & Behaviour (25 pts)
Claimant has made 2 or more claims in the past 3 years (same or different insurer)
Claimant is unusually knowledgeable about claims process / uses legal jargon unprompted
Claimant resists independent assessment / wants to settle without inspection / pressures for speed
🔍 Evidence & Witnesses (25 pts)
No independent witnesses to the incident (or witness is a family member / close associate)
No CCTV footage available despite incident occurring in a monitored area
Police report obtained on same day of claim submission (possible pre-arrangement)
Third party involved is known to, related to, or referred by claimant (staged accident pattern)
Fraud Risk Score
0/100
Risk Level
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Triggered Red Flags
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Fraud Reporting Channels
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Important Disclaimer
This tool is for educational and preliminary assessment purposes only. Red flags do NOT prove fraud — they indicate areas requiring further investigation. Many legitimate claims share some characteristics with fraudulent ones. Final fraud determination requires professional investigation, legal process, and due process. Never falsely accuse a genuine claimant.