Identification of Fraud
SIU works directly with other departments within APEX (Claims, Surveillance, Social Media – Background) to assist in identifying red flags on cases where investigations are being conducted. At APEX, we believe communication is essential in combating fraud. When red flags are identified a plan of action and recommendations are made in opening an SIU investigation.  SIU provides assistance to claims examiners on potentially fraudulent cases where red flags exist.

Investigations
SIU will review the claim file where red flags exist to make a determination if a reasonable belief threshold is met to submit a fraud referral with the California Department of Insurance and appropriate District Attorney’s Office. While conducting the investigation it is the goal of SIU in determining if the elements of fraud are met. When necessary, recommendations will be made by SIU to further strengthen a fraud referral. At APEX, we take a strategic approach with our SIU investigations where there is an increase in successful prosecutions.