Technology creates many benefits in the life insurance sales process and in underwriting. It also opens up opportunities for fraud. I conducted an interview with Paul Marquez, vice president and Kevin Glasgow, VP of Investigative Solutions—both from Diligence International Group, LLC. Both Paul and Kevin are involved in mitigating the risk of insurance fraud, and I have asked them to help explain the types of fraud they are seeing and how to mitigate the risk. Let’s start with:
Why is it important that companies mitigate the risk of fraud? Afterall, isn’t the cost of fraud baked into the price of doing business?
Well, yes and no. Fraud costs everyone. Overall, the Coalition Against Insurance Fraud estimates that fraud costs consumers over $308 billion annually. This has to be “baked” into the premiums we all pay for insurance coverage, or else insurers would go out of business. For life insurance fraud, it is difficult to put a number on the true cost for many reasons, but one is that it is difficult to detect if the deaths occur after the policy has been in force more than two years. Simply put, companies may be paying claims that they do not know are fraudulent, which makes the cost of fraud difficult to quantify.
I would also like to point out that companies that do not have strong controls will be targeted and will potentially pay a price much higher than anticipated, and certainly higher than competitors. We have heard stories of the same applicant attempting to purchase online policies with the same company over 20 times using slightly different parameters to find what will and will not kick out. We have also heard sales calls where the insurance agent is telling the caller the thresholds used by their company along with ways to get around other, non-financial, controls such as IP addresses.
From a public policy perspective, fraud shouldn’t be tolerated and, in fact, most states have requirements that insurers have fraud detection and mitigation plans to protect the public and the company against the financial impact of payments due to fraud.
Okay, so we now know that as consumers of insurance, we all pay for fraud. When you think of fraud, what types of fraud are there?
First, there are two main types of fraud: Opportunistic fraud and systemic fraud. Both are important to mitigate, but the impact on insurance companies and how they manifest are different. Opportunistic fraud, sometimes referred to as reactionary fraud, is in response to something that has happened to the proposed insured. Some examples include a recent change in health, financial issues, or legal issues. These tend to manifest as misrepresentations on an application related to these topics. Traditional tools to mitigate the risk of this include obtaining medical records and a paramedical exam. Today, we see more reliance on records from prescription drug warehouses and companies that aggregate lab results.
Systemic fraud, on the other hand, is pervasive, organized, and often more difficult to detect. Nearly all systemic fraud with life insurance involves an imposter posing as someone who is at high-risk for an early death. The applicant is not the insured although the insurance company is led to believe that the applicant is the insured. The result is the issuance of what is essentially a fraudulently obtained contract that is a wager on the insured’s early death. Perpetrators of systemic fraud are often well-versed in how life underwriting works, the tools used (along with their strengths and weaknesses), and how to get the death records to match so the death benefits will be paid. There are many organized groups and rings that study the insurance industry, test our methods, and then seize on opportunities when processes change.
I want to come back to this systemic fraud and how it is done. First though, I have to ask, has this changed since COVID, and if so, how?
The schemes themselves have not changed per se—we have seen wagering contracts and switched identities for decades. What has changed since COVID are the methods and opportunities for the schemes to succeed.
Can you elaborate?
Certainly. COVID was a catalyst to many changes in how insurance companies operate. Many of those changes were already in the development and testing phase when COVID hit, and then the changes were catapulted into the forefront when COVID hit.
Some of these changes include moving away from the traditional safeguards for mitigating these risks such as higher thresholds for medical records, paramedical exams, and agent involvement. In some cases, the requirements were eliminated entirely. This was a direct result of the difficulty in getting these requirements when business hours were reduced or closed, and social distancing was the norm.
We also began more automated solutions and accelerated processes which rely on new digital tools. These digital tools are effective in most cases, but they were not designed to defeat the type of systemic fraud we see as evidenced by the increases.
Top all of this off with the push automation for certain claims. Many companies are not requiring death certificates, and death records are easy to falsify.
This makes life insurance a perfect environment where there is little risk of getting caught, and even if one does, generally there are few legal ramifications if any.
You mentioned new, digital tools for underwriting. Do they work?
Yes, to a point. The new digital tools are great, but like all tools, they have their limitations. Prescription checks and lab checks do not have 100 percent coverage, and if someone is interested in defrauding an insurer, there are ways around detection which, for obvious reasons, would be inappropriate to share. Also, these tools are not adept at detecting the true identity of the person who is making application for the coverage. This is the biggest threat I see to the financial health of insurance companies
Can you expand upon that?
Sure. While we are seeing more health misrepresentations on applications within the claims we are investigating, we see the largest threat to be the systemic fraud from applications taken by people posing as someone else when applying for coverage. Fraudsters do this in a couple of ways. First, they can steal the identity of a person who is either ill or at a high risk of death. Once they steal the identity of this person, they pose as that person when applying for life insurance. The second way to do this is to create a synthetic identity.
Interesting. What is a synthetic identity and how can they be created?
Synthetic identities are made-up identities that do not represent a real person. They are fake, and this is hitting the financial industry particularly hard. Some prominent sources including the Federal Reserve Board and Forbes have stated that this type of fraud is the fastest growing financial fraud, and life insurance is not immune. To create a synthetic identity, the perpetrator must first choose the name, Social Security number, and date of birth that they want to create. They then apply for credit knowing the credit will initially be declined, but this creates a profile with the credit bureaus. Rinse and repeat. They continue to apply for credit, and as the application history builds, so does the profile of the synthetic identity. Eventually, they will get some level of secured loan which they pay off. This raises the credit profile. They continue borrowing and paying off the credit until they get it to the point that they perform a “break out” by taking out larger loans and then disappearing.
In the context of life insurance, they find an unidentified body and claim it as the synthetic person, or they simply falsify death records.
Detecting a synthetic identity is difficult because the perpetrators spend years cultivating them. Even the credit bureaus are having tremendous difficulty with this which is why we have heard and believe that some form of biometric identity verification will become standard for certain financial transactions in the not-too-distant future.
Of the two schemes, which is the most common?
As sexy and concerning as synthetic identities are, stealing the identities of people at high risk of an early death and then posing as that person when applying for coverage is by far the greatest concern. This scheme isn’t new. What is new is the degree in which it is occurring due to the reasons we have already discussed. As to synthetic identities, what is concerning is when the identity stolen has multiple synthetic identities, as described below.
Keep in mind that there are organized groups who perpetrate life insurance fraud and whose members will have multiple identities that are used for different purposes. A person’s medical records may have one date of birth, but the person has other dates of birth and social security numbers they use for other records such as life insurance, legal matters, etc. This allows fraudsters to circumvent current underwriting tools looking for prescriptions or lab results, as the identifiers provided on the application don’t match the identifiers on the potential records. It also becomes easy to switch identities at time of death so that the person who died becomes the person who is on the insurance policy, which has aged to the point where the claim is unlikely to be questioned. We’ve learned that in many cases, the information reported on death certificates has been self-reported to the funeral home by the insured’s “family.” In reality, the “family” are other members of these organized groups who provide the funeral home the identifiers that match the identifiers on the policy. Assuming the policy is outside the contestable period, the claim receives little scrutiny and the benefits are paid.
How can an insurance company protect itself from systemic fraud and wagering contracts?
The best way to mitigate the risk of these types of contracts is to know the actual identity of the applicant—not who they say they are, but who they actually are. Checking that the name on the application has a real credit record doesn’t stop this type of crime. Insurers have to identify the applicant despite who they claim to be. This is true whether the applicant is a sibling posing as someone who is involved in gangs or whether the applicant is posing as the patient whose identity they stole.
Knowing the applicant involves many factors including database verification techniques and knowing the actual location of the applicant—not the IP address, but the physical postal address where the applicant is. We also believe that biometrics will become the new norm in a few years. The financial industry is ahead of the insurance industry on this, but it is bound to happen. Biometric identification can take many forms including voice patterns, facial recognition, and even how a user interacts with their cell phone.
It is because of the fraud we see getting through underwriting that we developed Prodigi. Prodigi is a software suite of tools that was designed specifically to speed the life insurance application process while mitigating the risk of the type of fraud we see getting through underwriting today.
Life InsurTech Growth From Producer Licensing Automation To Life Fulfillment Platforms
I attend multiple industry conferences every year, focusing on both life insurance and technology. These events provide opportunities for solution providers to showcase their products and services through exhibitions, speaking engagements, and sponsorships. Among the exhibitors I’ve come to know over the past two years, AgentSync stands out. They offer a cutting-edge insurance infrastructure that effectively connects carriers, distributors, and agents. I’ve consistently heard positive feedback about their solutions for streamlining the onboarding process of carriers, distributors, and producers for licensing and appointments. My aim is to introduce another solution that enhances efficiency and reduces costs within the life insurance sector.
During my recent visit to the Life and Annuity Conference in Salt Lake City, UT, organized by LIMRA, LOMA, ACLI, and the Society of Actuaries, I had the opportunity to explore various booths. At the Zinnia booth I learned about an exciting development: Zinnia had recently acquired Policygenius. Formerly known as Se2, Zinnia is a prominent company specializing in life and annuity technology and digital services. Policygenius, on the other hand, has demonstrated astute decision making by focusing on innovative InsurTech solutions for both back-office and front-office operations. As an industry influencer, I am particularly interested in understanding their new platform, Policygenius Pro. To gain insights into the platform’s features and the advantages it offers to distribution, I reached out to my contact at Policygenius for further clarification.
I want to conclude this article about the growth and evolution of technology. I know many advancements originated from COVID, but AI and the next generation who are needing life Insurance is a big driver. This is why I keep saying there is a hybrid approach.
Managing producer licensing (the right way) is time-consuming and expensive
For all but the smallest of insurance agencies and brokerages, managing state-by-state and LOB-by-LOB producer licensing is a hassle you know all too well. Tasks that were simple when you only had one or two agents working in a single state turn into complicated and time-sucking jobs as your insurance business grows.
Managing appointments, license validation, signatures, onboarding, renewals, tracking continuing education credits, off-boarding producers—and more—are some of the challenges that undoubtedly consume more of your agents’ and other staff’s time than anyone would like.
Time equals money, particularly for revenue-generating roles like producers. If it takes too long to get producers onboarded and legally ready to sell, the business suffers and the producers themselves aren’t happy. At a time when experienced insurance producers are retiring from the workforce and those still around have their choice of brokerages to work with, it’s no question that they’ll choose the organizations that provide the easiest, fastest, and most modern onboarding experience.
Then there’s the cost of human error. Not only are manual, repetitive tasks a poor use of everyone’s time, they’re also subject to mistakes. Even what seem like small typos or oversights can end up getting your agency or brokerage into regulatory hot water or an E&O claim—both of which can get costly in dollars and in reputation.
Automating compliance with modern technology saves money
Now, imagine you could wave a magic wand and simply rest assured that every producer has a valid license and the necessary carrier appointments while your administrative and operational staff have all the information they need to onboard producers and manage license renewals—without a paper chase.
Automating producer license management with the right tech solution can make this dream come true.
For insurance brokerages looking to remove the cost, time, and hassle from producer license management, AgentSync offers a new breed of compliance management solutions. Just a few of the ways it helps reduce costs for agencies and brokerages include:
AgentSync provides a software-as-a-service that does all of this and more. At its core is the belief that compliance should never be an obstacle to growth. In fact, compliance should be so simple that you’re free to focus on every other aspect of your business while knowing your producers are right with their licensure, appointments, renewals, and more.
“Individual brokers are still the future of insurance, and your bottom line depends on getting them going and then getting out of their way,” said Niji Sabharwal, CEO and co-founder of AgentSync. “Making compliance an automatic background function delivers revenue, reduces risk, and makes it easier than ever to excel at your business.” Learn more about AgentSync at https://agentsync.io.
Policygenius Pro platform increases term life production
Policygenius Pro is a turnkey life insurance fulfillment platform that allows financial professionals and independent agents to offload the administrative burden of term life insurance fulfillment while staying in the loop every step of the way.
As an innovator in the life insurance space, Policygenius built an online insurance marketplace that combines cutting-edge technology with the expertise of real licensed agents to help consumers get the insurance coverage they need without the headache. Since the founding of the company, Policygenius has grown to be the largest producer of term life insurance in the country. Building on their custom-built CRM system, superior insurance products, and unique carrier integrations that have powered Policygenius’ success. Policygenius Pro launched in 2022.
To date, the platform has helped partners increase their term life production five-fold and reduced the time they spend on a term life insurance application by up to 88 percent. By leveraging Policygenius Pro, financial institutions can grow their term life offerings for their clients while offloading the cumbersome backend work that comes with term life fulfillment.
With Policygenius Pro, financial professionals can refer their clients for coverage in less than 60 seconds through an advisor portal or a co-branded landing page. The portal features two referral pathways: A simple drop ticket process and a refer with quotes option. The built-in quoting option allows advisors to review real-time quotes with their clients and explore options across product offerings, including fully underwritten and accelerated policies.
From there, a team of experienced non-commissioned agents guide the client through the application process from quotes all the way through to their in force policy. This includes scheduling any medical exams, completing the application paperwork, and collecting any medical records or requirements during underwriting. The referring advisor is kept informed throughout the process through a real-time case reporting feature and can jump in at any point in the process to check in with their client.
You can visit Policygenius Pro at https://pro.policygenius.com.
Significant growth in life insurance technology
Life insurance technology is experiencing significant growth and innovation in recent years, driven by various factors that have reshaped the industry landscape. There are many key reasons behind the rapid expansion of life insurance technology. The growth of life insurance technology can be attributed to its ability to streamline processes, improve customer engagement, leverage data analytics, offer personalized products, enhance distribution channels, and integrate with complementary ecosystems. As technology continues to evolve, the life insurance industry is poised for further transformation—delivering greater convenience, efficiency, and value to policyholders.
Technological advancements are transforming the sales process for life insurance, driven by the preferences of Millennials and Gen X. While these generations gravitate towards online interactions, they still value the guidance of insurance professionals. As a result, the industry is adapting by combining digital convenience with the expertise of agents. The hybrid approach allows customers to utilize online tools for research and policy selection while ensuring access to knowledgeable professionals or personalized advice. The goal is to create a seamless customer journey that meets the evolving needs of tech-savvy consumers, providing convenience and expertise in equal measure.