Supporting a commercial resolution in a complex fraud claim

Complex claims can often be intensive in terms of time, costs and effort. However, when our claims team are presented with such a claim, they consistently strive to find resolution. Our commitment to service and ease of doing business with has been evidenced clearly in this particular case.

Identifying a major internal fraud

A large company, our insured customer, discovered a significant internal fraud. After investigation, it was discovered the fraud had been carried out by a senior leader from within the company. Over a sustained period, the individual raised fictitious invoices and authorised fraudulent payments.

The customer notified us under their crime policy, and were seeking indemnity for the primary loss. Additionally, they were seeking cover for the associated expenses, and mitigation costs. 

Overcoming prolonged delays and limited engagement

We conducted a thorough investigation into coverage to validate the claim. This required the collection and review of detailed supporting documentation.

However, despite sustained efforts over a six-year period, progress was limited. Requests for information submitted via the broker and directly to the company were frequently delayed or incomplete. Key documents remained outstanding, and overall engagement from the customer was minimal.

This resulted in a significant challenge - with a large reserve held over several years, plus limited ability to progress.

Taking a pragmatic, commercially-focused approach

Our claims team adopted a pragmatic approach to this case. They recognised that the loss was largely covered, and that further attempts to obtain full documentation would likely result in further delays and costs.

We initiated direct dialogue with the company's CEO. This was with the goal to explore the potential for a commercially-driven resolution. This marked a shift from a purely forensic process to a more outcome-oriented approach.

Following the discussion, our claims handler assessed the available information and calculated a balanced 'sweet spot' settlement figure. This reflected both known losses and evidential gaps.

Reaching a fair settlement

A commercial offer was presented to the customer and, following negotiation, a favourable settlement was agreed.

This approach created a positive outcome for both parties. The customer avoided the time-intensive process of sourcing historic documentation, while still achieving a fair result.

For us, as the insurer, the strategy delivered a more efficient resolution. It avoided the need for extensive investigation, including looking into costs related to pursuing the perpetrator.

Delivering value through flexibility and focus

Although the claim remained open longer than anticipated, this case highlights the importance of adaptability in complex claims.

By maintaining focus and applying commercial judgement, our claims team successfully brought the matter to a conclusion. The result demonstrates how a flexible, solution-led approach can deliver a fair, efficient, and mutually-beneficial outcome.