CIP039 - Fraud Prevention and Awareness

Outline info
Last revision date 2013-10-01 18:43:54.794
Last review date 2013-11-18 00:15:11.149

Subject Title
Fraud Prevention and Awareness

Subject Description
Fraud Prevention and AwarenessStudents will learn how fraud may arise under insurance policies and what initiatives the insurance industry had advanced to fight fraud. The cost of fraud is discussed as well as the laws that affect how insurers must handle claims investigations and settlements. Property, liability and automobile claims are covered.
Pre-requisite: CIP013

Credit Status
One credit

Learning Outcomes
Upon successful completion of this subject the student will be able to:

1. Discuss how insurance fraud affects our society, and how consumers generally view insurance fraud and identify strategies that restrict fraud.

2. Define insurance fraud, outline some issues related to proving fraud, and discuss the parts of an insurance contract that help to deter and control fraud.

3. Outline some general principles of law that affect insurance transactions, especially claims investigations, and discuss the concept of good faith.

4. Discuss how brokers, agents and underwriters can be effective in controlling insurance fraud and identify characteristics that should trigger further investigation of a risk to be insured.

5. Discuss information gathered on risks, how it can be used to limit insurance fraud, and discuss alternative types of policies that can discourage insurance fraud.

6. Outline a review program to assess a policy for potential fraud at renewal time and discuss how a renewal policy might involve fraudulent activity.

7. Describe the adjuster's function in managing claims to detect and deter fraud, and outline the key aspects of investigations of suspicious claims.

8. Formulate interview questions, understand the role of experts when investigating claims, and discuss how to prepare to give evidence in court.

9. Identify indicators of arson-for-profit and other fraudulent property claims, and discuss the typical approach taken to defend against claims arising out of arson.

10. Outline the appraisal process and discuss how damage claims may be subject to fraud.

11. Discuss the relationships between parties involved in liability claims and how fraud may arise under liability policies.

12. Identify red flags common to liability claims and discuss the special focus of liability claim investigations.

13. Describe how staged accidents can occur, and outline the aspects of investigating automobile claims to control and prevent fraud.

14. Identify indicators of possibly fraudulent automobile claims and associated injury claims.

15. Discuss the aims and programs of various organizations involved in fraud prevention and control.

16. Discuss the benefits and role of Special Investigative Units.

17. Identify and discuss the codes of ethics and other standards applicable to claims handlers, including privacy guidelines.

18. Discuss the concept of fairness and outline the laws relating to unfair and deceptive acts and practices.

Cheating and Plagiarism
Each student should be aware of the College's policy regarding Cheating and Plagiarism. Seneca's Academic Policy will be strictly enforced.

To support academic honesty at Seneca College, all work submitted by students may be reviewed for authenticity and originality, utilizing software tools and third party services. Please visit the Academic Honesty site on for further information regarding cheating and plagiarism policies and procedures.

All students and employees have the right to study and work in an environment that is free from discrimination and/or harassment. Language or activities that defeat this objective violate the College Policy on Discrimination/Harassment and shall not be tolerated. Information and assistance are available from the Student Conduct Office at

Accommodation for Students with Disabilities
The College will provide reasonable accommodation to students with disabilities in order to promote academic success. If you require accommodation, contact the Counselling and Disabilities Services Office at ext. 22900 to initiate the process for documenting, assessing and implementing your individual accommodation needs.


Topic Outline

  • The cost of insurance fraud
  • Fraud, defences and the law
  • New business and renewals
  • Property, automobile and liability claims
  • Organizations and initiatives against insurance fraud
  • Ethics awareness

Mode of Instruction
Students learn through classroom lectures, discussions, and question and answer periods.

It is the student's responsibility to save documents, articles and notes that the instructor has provided on Blackboard or in class. Students will not be able to access Blackboard as of the last day of the student's class.

Prescribed Texts
Textbooks must be purchased directly from the Insurance Institute of Canada (416-362-2588). College fee does not include textbook.

Required Supplies
A notebook, pens, highlighter

Promotion Policy

Grading Policy
A+ 90%  to  100%
A 80%  to  89%
B+ 75%  to  79%
B 70%  to  74%
C+ 65%  to  69%
C 60%  to  64%
D+ 55%  to  59%
D 50%  to  54%
F 0%    to  49% (Not a Pass)
EXC Excellent
SAT Satisfactory
UNSAT Unsatisfactory

For further information, see a copy of the Academic Policy, available online ( or at Seneca's Registrar's Offices.

Modes of Evaluation

Case Studies 10%
Quizzes (3) 30%
Midterm 20%
Final Exam 40%

Those students electing to obtain a credit from the Insurance Institute of Canada (IIC) will write the IIC final exam, which will be written outside of Seneca College. Details regarding the registration process, payment, and date/time/location will be communicated to the class by the Seneca College course instructor.
Those students not wishing to pursue the IIC credit will write a Seneca College final exam. In both cases, students who are successful will receive a Seneca College credit.

To obtain the IIC credit: students must achieve a minimum mark of 70% on the term work (counted out of 100) and 55% on the IIC final exam
(counted out of 200) for a combined minimum total mark of 180 out of 300. To obtain Honours, an overall course grade of 80%, including a minimum final exam mark of 80% (240 out of 300) is required.

Approved by: Susan Horne