Written by Jamie Lankey, Technical Service Director, RGI Solutions
A sick note takes about three minutes to alter. Change the date, adjust the diagnosis, lift the GP’s name from somewhere else. Done badly, it falls apart straight away. Done well, it moves through a claims process that was never really built to catch it.
Income Protection fraud does not arrive with a warning. It arrives with documentation and a consistent story. And unlike a staged road traffic accident or an inflated home contents claim, it does not end after a single event. It has to be kept going, sometimes for years. That is what separates it from most other fraud types in the market.
The gap between what is reported and what is real
Not every exaggerated Income Protection claim starts with a deliberate plan to deceive. Some begin with a genuine condition that improves quietly while the claim continues running. Financial pressure fills the space between recovery and disclosure. The claimant finds ways to manage what their GP sees. By the time the gap is significant they have usually been maintaining that version of events long enough that it feels normal to them.
Others are more calculated from the start. A claimant who understands their condition well can present to a GP in ways that reliably produce ongoing certification, particularly where the condition does not lend itself to objective clinical measurement. Chronic pain, fatigue, and mental health conditions are harder to verify through examination alone, and people intent on exploiting the system know that.
Social media has changed this work considerably. A claimant reporting being unable to leave the house but posting from a family holiday or night out is not an edge case. It comes up regularly. People compartmentalise. They assume no one is paying attention. Open source intelligence is now one of the most consistent early indicators that a claim is worth looking at more carefully.
The document in front of you
Sick notes, GP letters, occupational health assessments, specialist reports. These are the documents that underpin an Income Protection claim, and they are also the ones most likely to have been interfered with. The range of sophistication is considerable. At one end there are crude alterations: a date changed in basic software, a signature copied from another document. At the other end are fabrications that pass visual inspection entirely and require forensic examination to identify.
Not every document anomaly points to fraud. GP systems make errors. Dates get formatted inconsistently. A name gets misspelt. The job of an investigator is to work out what happened, not to assume the worst. But visual inspection alone is no longer reliable. The volume of document manipulation seen across Income Protection claims means that forensic examination is increasingly routine rather than exceptional.
When it goes further
The most serious cases are not individuals acting alone. They involve people working together. A claims management company prepared to coach testimony. A medical professional willing to certify a condition that does not exist. Coordinated claims submitted across multiple insurers at the same time, with documentation designed to look consistent. These cases are not common, but they carry weight because they represent a deliberate effort to exploit a product that exists to support people when they are most vulnerable.
Who this is about
Every Income Protection claim, genuine or otherwise, represents a person who is or says they are unable to work. The loss of income, the uncertainty, the pressure at home: these are real regardless of whether the claim holds up. Investigation done properly starts from inquiry rather than suspicion. When a claim is genuine, a thorough investigation confirms it. When it is not, investigation protects every policyholder whose premium contributes to the fund that pays claims. Fraud in this sector raises premiums and makes it harder for people who genuinely need this product to access it.
What this requires
Effective investigation in the Income Protection space is not about applying general resources to a specific problem. The signs that a claim needs a closer look do not always present themselves obviously. They emerge from experience, from having reviewed enough claims and documentation to recognise when something is slightly wrong. It also means operating properly within the relevant framework. GDPR, RIPA, the ABI Code of Practice, Consumer Duty. Not treated as compliance, but because investigation that takes shortcuts produces evidence that cannot be relied upon when it matters most.
IP fraud does not always look like fraud. That is precisely why the people investigating it need to know what they are looking for.
RGI Solutions’ Special Investigation Unit works exclusively within the insurance sector. If this reflects challenges you are seeing in your own book, we will welcome a conversation.
