Leading the loss adjuster to get big ticket fraud claim paid

The client is an entertainment brand whose business model involves an element of selling tickets to the general public.  An unscrupulous employee manipulated the ticketing system to steal a large sum of money. Suspect identified, with a police investigation underway, loss adjusters were called. 

The loss adjuster asked the client for the results of police investigations, insisting that he could not conclude his report to insurer until the police investigations were complete. As a result, the client faced major delays in getting the claim paid as procedures in such financial crime cases can take a long time to build a case. Knock-on effects could have a significant impact on the business’ cash flow. 

Howden approached the matter in a swift and decisive fashion. 

We pointed out to the insurer that it wasn’t a contracted requirement under the Crime policy to involve the police where the loss was due to employee dishonesty. This insight made the loss adjusters’ stance moot. Since there was no requirement under the policy for a police report to be lodged, the results of the police case were irrelevant for the purposes of policy indemnity, once the loss was verified.  And the loss could be verified through other means.

The insurer quickly came round to our way of thinking and instructed the loss adjuster to verify the loss.

Results

The loss to the client, amounting to several hundred thousands of dollars, was paid in full (subject to deductibles, of course) shortly afterwards.