Business interruption insurance typically covers losses sustained by a business due to disaster-related damages (including the COVID-19 pandemic) that affect the entity’s ability to continue operating in the manner it had before the event.
相关的 业务中断保险单 应该定义实际的覆盖范围吗, 损失计算方法, limits of coverage for claims and procedures for filing a claim.
法医 accountants have the expertise and understanding to prepare business interruption claims and can evaluate potential fraud risks surrounding them. Whether working with the insured in preparing a claim or the insurer in reviewing, there are several key areas that may be susceptible to fraud, 包括:
- 损失期间 – from the date of the event until the time the physical condition of the business is corrected. These dates can be manipulated as part of a claim.
- 基准期 – operating results in prior base periods can be manipulated, 造成潜在的夸大损失索赔.
- 减轻损失 – cost savings that would reduce a business interruption claim may be incurred but not reported.
- 帐簿和记录 – financial records in pre-loss and post-loss periods must be accurate.
法医 accountants may uncover any of these red flags as part of the discovery process with adjustors or vendors, 在回顾索赔历史时, 接受员工热线的提示, or through an analytical review of the claimant’s financial statements.
基于他们对索赔的初步审查, the client or insurance carrier should determine whether further investigation is warranted. An investigation by the insurance carrier’s own investigation team, 或者与外部法务会计师合作, provides the expertise necessary to assess the potential red flags of fraud.
If you have questions or concerns about your business interruption or insurance claim, 请联系 汤姆·普拉特 or 布莱恩•韦伯斯特.
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