Introduction
A Special Investigations Unit, almost always referred to as an SIU, is the specialist team within an insurer responsible for investigating suspected fraud. SIUs sit at the heart of an insurer’s counter-fraud capability, combining specialist skills, dedicated tooling, and close working relationships with claims, underwriting, and external partners.
The structure, scope, and reporting lines of SIUs vary between insurers, but their purpose is consistent: to investigate suspicious activity, gather evidence, and support decision-making on cases where fraud is suspected.
What an SIU Does (Plain English)
An SIU is the team that picks up cases where standard claims handling identifies potential fraud. Where a claims handler can flag a concern, the SIU investigates it in depth.
Typical SIU responsibilities include:
- Reviewing claims flagged for potential fraud
- Conducting interviews with claimants, witnesses, and suppliers
- Gathering evidence including documentation, telematics, and external data
- Working with external investigators, forensic specialists, and law enforcement where appropriate
- Supporting recovery action and prosecution where evidence warrants
How SIUs Operate Under the Code of Practice
Part 15 of the General Insurance Code of Practice 2020 establishes specific standards for claims investigations in Australia. These include requirements for:¹
- Investigation activity being proportionate to the risk
- Investigators being properly trained and qualified
- Customers being kept informed during investigation
- Surveillance only being used where alternatives have been considered
- Investigators not making threats, promises, or inducements
- Authority being obtained before fraud is alleged
These standards shape how Australian SIUs operate, both internally and through external investigators they appoint. The Code Governance Committee oversees compliance with Code obligations.⁴
How SIUs Are Structured
SIU structures vary depending on the size and complexity of the insurer. Larger Australian insurers may have separate teams for motor, CTP, casualty, property, and organised fraud. Smaller insurers may operate a single team that covers all lines of business.
Effective SIUs typically include a mix of skills, including former police officers, claims specialists, analysts, and digital forensics expertise. The Australian and New Zealand Institute of Insurance and Finance (ANZIIF) offers specialist training on claims investigation standards under the Code.²
How SIUs Interact with Other Teams
SIUs are most effective when they are embedded in the wider claims operation rather than treated as a separate function. Claims handlers refer cases in, the SIU investigates, and the outcome feeds back into both individual claim decisions and broader detection improvements.
Strong relationships with the IFBA, state regulators (such as SIRA in NSW), and law enforcement are also important. Fraud rarely sits in a single business area, and effective response often requires coordinated action.³
Challenges Facing SIUs
Modern SIUs face several recurring challenges:
- Volume of referrals can exceed investigation capacity, requiring careful prioritisation
- Fraud tactics evolve faster than traditional investigation methods alone can keep pace with
- Evidence gathering is increasingly digital, requiring specialist tools and skills
- Cross-border and organised fraud requires collaboration beyond a single insurer
Role of Analytics and Workflow
Modern SIUs rely heavily on analytics and structured workflow tools. Analytics surface cases that warrant attention and provide investigators with the context they need to act quickly. Workflow tools ensure that cases move efficiently through investigation, decision, and outcome.
Where SIUs operate with integrated detection, investigation, and case management, productivity and accuracy both improve significantly.
Related Topics
Claims fraud: detection, investigation, and prevention
Insurance fraud investigation
Workflow management in fraud and compliance
Entity resolution and risk visibility
Sources & further reading
¹ Insurance Council of Australia — General Insurance Code of Practice 2020, Part 15 (Claims investigation standards)
² Australian and New Zealand Institute of Insurance and Finance (ANZIIF) — Claims Investigation Short Course
³ Insurance Fraud Bureau of Australia — insurancecouncil.com.au/consumers/insurance-fraud
⁴ Code Governance Committee — insurancecode.org.au
