FNOL fraud indicator checklist

🎯 purpose operational checklist used during fnol capture to identify potential fraud indicators before claim routing decisions are finalized ✅ operational workflow initiate checklist review complete the fraud indicator assessment during fnol capture and before operational routing decisions are finalized assess all applicable indicators review each indicator against available evidence, policy history, and submission quality record indicator outcomes tick every confirmed indicator and retain supporting rationale within the claim record apply routing threshold where two or more indicators are present, route the claim silently to the special investigations queue retain audit evidence ensure the completed checklist and supporting review notes remain attached to the operational claim file 🛡 fraud indicator controls loss within 30 days of inception or of a cover increase prior similar claims on this policy or by this policyholder narrative inconsistent between notification channel and documents loss date shortly before lapse or cancellation effective date no plausible third party evidence where the loss type normally has some round figure claimed amounts across multiple items reluctance to provide originals, or documents that look regenerated notification by an unrelated third party with recorded interest in the payout ⚠️ audit evidence retention the completed checklist forms part of the formal claim audit record and must remain attached to the claim file regardless of routing outcome 🔎 quality control and escalation guidance validate that all indicators selected can be supported by evidence contained within the claim file escalate repeated indicator combinations involving the same intermediary, geography, or claimant profile to siu management avoid unsupported assumptions or speculative commentary within operational notes ensure indicator assessments are completed consistently across all intake channels review checklist completion quality during operational qa sampling and governance reviews